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Ethics Committee Briefing Paper on Determining What Constitutes a Health Emergency and How to Respond in the Course of Anthropological Research with Human Subjects
Briefing Paper on Determining What Constitutes a
Health Emergency and How to Respond in the Course
of Anthropological Research with Human Subjects
AAA Committee on Ethics
Prepared by Lauren Clark and Linda Whiteford
Preface: In November 2000 the Committee on Ethics was asked to draft guidelines to address the question, How can anthropological researchers respond appropriately to health emergencies they encounter in the course of their research? Members on the Committee on Ethics have prepared this preliminary draft of proposed guidelines for health emergencies.
Official Sources of Guidelines: The Committee on Ethics recognizes that scientific investigations are regulated through a process of internal review for the protection of human subjects. In particular, the U. S. Department of Health and Human Services operates the Office for Human Research Protection, charged with monitoring compliance of research supported by HHS to standards outlined for the protection of human subjects http://www.hhs.gov/ohrp/. Universities and affiliated institutions also establish and monitor the protection of human subjects in research through a program of internal review. Finally, investigators are held to codes of ethical conduct adopted by professional and scientific organizations, including the American Anthropological Association Code of Ethics. The Committee on Ethics recommends that anthropologists and anthropology students conducting research with human subjects become familiar with all applicable guidelines and codes of ethical conduct and adhere to them in protecting human subjects from research risks and maximizing their benefits through research participation.
Background Information on Ethical Conflicts and Advocacy: The decision to treat or not treat a human illness or condition may be fraught with ethical conflicts resulting from the nature of the illness or condition, the relationship of the researcher and subject, and the responsibilities and qualifications of the researcher. The AAA Code of Ethics states the following about ethical conflicts: " Anthropological researchers must expect to encounter ethical dilemmas at every stage of their work, and must make good-faith efforts to identify potential ethical claims and conflicts in advance when preparing proposals and as projects proceed. A section raising and responding to potential ethical issues should be part of every research proposal." Furthermore, taking action in response to a human subject's or research population's illnesses or health risks involves a research stance of advocacy. As stated in the AAA Code of Ethics, "Anthropologists may choose to move beyond disseminating research results to a position of advocacy. This is an individual decision, but not an ethical responsibility." Although it may be an individual decision to intervene in the course of a health emergency, it is the purpose of these guidelines to support researchers in making decisions about health emergencies and suggest sources of decision-making support as they select from among an array of responses to health emergencies.
Types of Health Emergencies: There are four types of health emergencies addressed in these guidelines. The types of emergencies are:
What Kinds of Preparations Can Researchers Make for Potential Health Emergencies in the Course of Fieldwork? Health emergencies can threaten both researchers and research subjects. Given that every situation arising in the course of fieldwork cannot be anticipated, we recommend that researchers consider in advance the local health status profile of residents and epidemiologic patterns of communicable illness, accident, and injury before entering the field and anticipate emergencies they may encounter personally and among residents in the research area.
Researcher Emergencies: With foresight, common emergencies faced by researchers in a particular area can be anticipated. In locations where communicable diseases are endemic, the researcher would be wise to obtain recommended immunizations prior to entering the field. Researchers should thoughtfully consider the benefits of purchasing medical evacuation insurance for members of their research team should their field setting warrant such emergency measures.
Research Subject Emergencies: Research subjects face health emergencies, as well, some as a direct result of participation in a research study and others during the course of their daily life. Certain types of research may involve the collection of tissue samples or other invasive procedures that could be implicated in the development of a resultant medical emergency for an individual study subject. It is the researcher's responsibility to determine the risks of study participation in advance of fieldwork, and make plans for the appropriate training of research staff in safe and effective administration of all study procedures. Contingency plans should be established for complications or side effects resulting from all study procedures. As with all research protocols, plans for the minimization of research-related risks to human subjects should be reviewed and approved by the appropriate committees and internal review boards.
Individual Health Emergencies: Health emergencies for individuals unrelated to research participation may arise during the course of daily life, and the anthropologist should consider in advance the role of the researcher in response to observed health emergencies. When reviewed in advance, profiles of health and illness alert the researcher to conditions in field settings. For health emergencies of individuals, researchers should design and obtain approval for protocols to guide the administration of pharmaceutical agents to individuals should individual health emergencies be observed.
Community or Population Health Emergencies: For health emergencies of communities or populations, researchers may arrange in advance for consultation on an as-needed basis with a health expert should a disease escalate to epidemic proportions during the course of fieldwork. Researcher interventions for health emergencies experienced by a population in the course of daily life should be undertaken with the guidance of intervention protocols and after consultation with experts.
Who Determines Whether a Situation is a Health Emergency or Not? Some anthropologists also have credentials (such as the Medical Doctor degree or Nurse Practitioner certification) that prepare them to diagnose and treat human health conditions. In these cases, the researcher may use his or her professional judgement and appropriate consultation with colleagues and specialists to determine whether or not a situation constitutes a health emergency and how to respond to the situation within his or her scope of practice.
Recommendations for Consultation about Health Emergencies: We recommend all researchers arrange in advance for consultation for potential health emergencies in field settings. Furthermore, we recommended researchers contact the Centers for Disease Control and Prevention (CDC) to discuss health situations that may be classified as population-level health emergencies. We recommend to the American Anthropological Association that an official relationship be established between AAA and CDC such that an official contact person be designated to respond to inquiries about health emergencies from researchers conducting anthropological fieldwork within the United States or abroad.