It’s Monday morning and I am sifting through the myriad of emails when up pops a request from an RDS General Adviser seeking ethical expertise. Intrigued, I put it to the top of my pile and get hooked when I read the title ‘Can this really be ethical?’ That’s for you to ask and me to answer, sort of.
So begins the week of the RDS London Ethics Lead, a rather rare breed in the RDS, but a growing one I hope. I am charged with helping general advisers help clients strengthen their funding applications so that they will not be turned down for funding on ethical grounds and later not rejected or amended by the Research Ethics Committee (REC). A simple task you may think, advising on ethics akin to advising on sock colour – a matter of opinion, of taste, of perspective. Perhaps so, perhaps not, let’s explore an example to find out.
An adviser approaches me to ask for advice on an application from an experienced clinician who thinks that she has found a way to find out how we know when people with addiction problems are abstaining whilst in therapy. The traditional method of ‘ask the patient’ is proving ineffective and the clinician feels sure that what would help is to conduct a simple blood test and measure alcohol level. Problem solved, ethical issues seemingly few. No horrible interventions, no placebos, no children, no animals, no risks? But what the adviser was concerned about was not what made me sit up and take notice.
The adviser was concerned that patients would be lured into having blood taken when they thought that all they were coming along for was a ‘chat’. That is of course of concern, but delve a little deeper into the moral maze and we find a host of issues. What will happen to the results of the tests – will they be sent to employers or insurers? Will a positive test result in therapy being stopped? If the test shows very high alcohol in the patient’s system will this put the mental capacity of the patient in question and will it put the therapist at risk? But what worried me most was that in addiction services there is a fragile relationship of trust that builds between patients and therapists and is essential to effective treatment. By introducing a seemingly innocuous blood test into this patient/therapist relationship it may be seen by patients as a test of whether their self-report is the truth or a lie. Thus trust may be damaged beyond repair and the patient may no longer attend therapy.
And so you see, what looks like an ethically free zone or a low risk study, emerges from the moral maze as a rather concerning one and one that is likely to be questioned both by funders and RECs.
So if you have the slightest ethical niggle, or something just doesn’t feel right please seek ethical input. The RDS can help and provide some strategies on how to avoid the minefield that can be found inside the moral maze.