The Ethics of Ethics Reviews in Global Health Research: Case Studies Applying a New Paradigm

With increasing calls for global health research there is growing concern regarding the ethical challenges encountered by researchers from high-income countries (HICs) working in low or middle-income countries (LMICs). There is a dearth of literature on how to address these challenges in practice. In this article, we conduct a critical analysis of three case studies of research conducted in LMICs.We apply emerging ethical guidelines and principles specific to global health research and offer practical strategies that researchers ought to consider. We present case studies in which Canadian health professional students conducted a health promotion project in a community in Honduras; a research capacity-building program in South Africa, in which Canadian students also worked alongside LMIC partners; and a community-university partnered research capacity-building program in which Ecuadorean graduate students, some working alongside Canadian students, conducted community-based health research projects in Ecuadorean communities.We examine each case, identifying ethical issues that emerged and how new ethical paradigms being promoted could be concretely applied.We conclude that research ethics boards should focus not only on protecting individual integrity and human dignity in health studies but also on beneficence and non-maleficence at the community level, explicitly considering social justice issues and local capacity-building imperatives.We conclude that researchers from HICs interested in global health research must work with LMIC partners to implement collaborative processes for assuring ethical research that respects local knowledge, cultural factors, the social determination of health, community participation and partnership, and making social accountability a paramount concern.

The Ethics of Ethics Reviews in Global Health Research: Case Studies Applying a New Paradigm

With increasing calls for global health research there is growing concern regarding the ethical challenges encountered by researchers from high-income countries (HICs) working in low or middle-income countries (LMICs). There is a dearth of literature on how to address these challenges in practice. In this article, we conduct a critical analysis of three case studies of research conducted in LMICs.We apply emerging ethical guidelines and principles specific to global health research and offer practical strategies that researchers ought to consider. We present case studies in which Canadian health professional students conducted a health promotion project in a community in Honduras; a research capacity-building program in South Africa, in which Canadian students also worked alongside LMIC partners; and a community-university partnered research capacity-building program in which Ecuadorean graduate students, some working alongside Canadian students, conducted community-based health research projects in Ecuadorean communities.We examine each case, identifying ethical issues that emerged and how new ethical paradigms being promoted could be concretely applied.We conclude that research ethics boards should focus not only on protecting individual integrity and human dignity in health studies but also on beneficence and non-maleficence at the community level, explicitly considering social justice issues and local capacity-building imperatives.We conclude that researchers from HICs interested in global health research must work with LMIC partners to implement collaborative processes for assuring ethical research that respects local knowledge, cultural factors, the social determination of health, community participation and partnership, and making social accountability a paramount concern.

El arte de negociar como una herramienta de creación de valor según la metodología de la Harvard Law School

El arte de la negociación es una estrategia fundamental en la toma de decisiones y un proceso mediante el cual las partes, en todas las áreas de la vida y en todas las disciplinas y profesiones, intentan resolver conflictos y llegar acuerdos, compatiblemente con sus necesidades e intereses. De una forma más sencilla, la negociación podría definirse como: “…cualquier comunicación entre dos o más personas con la intención de influenciar o persuadir” (R. Bordone, Harvard Law School, MA). Todos estos elementos destacan la importancia de desarrollar destrezas y competencias que fortalezcan este tipo de habilidad y la necesidad de conocer las reglas del juego de esta poderosa herramienta. Según la Escuela de Harvard, la forma más exitosa y provechosa de negociar es la recogida por el modelo integrativo-cooperativo, el que se base sobre premisas muy diferentes del tradicional modelo distributivo. Este último responde a nuestra forma de negociar más espontánea y lamentablemente desacertada, es decir, una forma de negociar que se reduce a un simple reparto de lo que haya sobre la mesa, sin visualizar, analizar posibles opciones negociadoras más allá de este simple reparto. Es un esquema que responde a una negociación “dura”, que se fundamenta en una concepción adversarial de las relaciones humanas (homo homini lupus, T. Hobbes), en donde hay un ganador y un perdedor, sin tintes intermedios. Al contrario, la idea con el modelo que propone la Escuela de Harvard, -el modelo integrativo-cooperativo-es uno por el que una negociación exitosa es aquella que “crea valor sobre la mesa” y que genera beneficios para todas las partes, no solo una de ellas. En otras palabras, el enfoque no es aquel por el que si uno pierde, el otro gana sino uno en el que la otra parte debe alcanzar un razonable nivel de satisfacción en sus requerimientos y demandas. Este modelo crea valor sobre la mesa inclusive más allá de los posibles beneficios que puedan conseguirse a partir de un determinado acuerdo; por ejemplo, ataja el conflicto y preserva las relaciones humanas, las que a menudo, en base al modelo tradicional (ganarperder) quedan perjudicadas. Finalmente, el modelo cooperativo es uno que abre la puerta a la empatía, la escucha activa, la transparencia y confianza; todos elementos que sin lugar a dudas facilitan las complejas relaciones interpersonales.