EDITORIAL
The importance of diversity of ideas in Ethics Commissions for analysis of research projects
Newton Kara-Junior
Professor colaborador, livre-docente e professor de pós-graduação da Faculdade de Medicina da Universidade de São Paulo - USP. Membro do Comitê de Ética para Análise de Projetos de Pesquisa do Hospital das Clínicas da FMUSP e da Comissão de Ética da Faculdade de Medicina da USP
With the advance in Medicine that in the last decades has been stamped by the practice based on evidence, in which clinic decisions are guided by results of scientific studies and no more only by the experience and perception of renowned professionals, more interest has progressively been pointed out on behalf of institutions engaged in teaching and medical assistance, by encouraging the carring out of clinic studies (1).
In institutions preferably linked to research, motivation of faculty professors for performing clinic research has also grown mostly due to interests in academic progression, governamental promotions, private sponsorships and pressures of graduation programs (2).
Along with the progress in Medicine, personal and social relationships have been growing fast as well. Concern and respect with less privileged and/or vulnerable individuals have been paid special attention in all decisions involving persons. Concepts and practices considered normal some time ago could be many times seen as exploratory and inhuman today.
Designed to ruling the limits of what can be considered ethically and morally corrected as to the carrying out of scientific studies involving human beings, Institutionals Commissions of Ethics in Research have also been improving to follow and make the progress of Medicine feasible, without ignoring the evolution of interpersonal relationships (3,4).
Knowledge in human psychology teaches that, in a group of study created for laying down guidelines and expressing opinions, it is typically risky to let people with similar features and interests be the only participants, so decisions can be made with moderation and impartiality. It was pointed out that radicalization of some ideas could be considered normal, a phenomenon known as polarization of opinions, if no divergent opinions are exposed. That is why judging commissions should be ideally heterogenious and be made up by members of all involved parts and, preferably, have divergent opinions, even if that attitude leads to complex discussions, generally without consensus and consequent slowness when decisions are taken. Nevertheless, according to this model, during which the dispute has arisen and the consensus is questioned, propensity turns out to be that one in which radical opinions void and judgement and impartiality prevail (5,6).
As a member of the Ethics Commission for the Analysis of Research Projects from the Clinic Hospital of the University of São Paulo, I found it unusual in the beginning to have a study group made up of, alongside researcher doctors, a representative of research subjects, a lawyer, a social assistant, a priest, a psychologist, a pharmacist, a biologist, a nurse and others. At first, I did not understand the relevance of discussing predominantly medical aspects with professionals from so many areas, some of them with no direct relation with the topic.
However, during the discussions of certain subjects I noticed how that ideological and cultural plurality is important. In my view, stamped by beliefs and notions acquired through the limited individual experience of life and slanted by specific goals, topics that were of simple and logical decision, seem many times to be complex and controversial. And after listening to all the parties, I even changed my mind. Therefore, I understood how important it is to value perception of people with different features, education, priorites and experiences.
In this context, we point out that even logical deduction could be relative, because making a logical decision will depend on the socio-cultural background of each person. That is to say, what is coherent for someone could not make any sense to someone else. In order to use logic thinking, it is necessary to have information / knowledge. In this case, someone who has more knowledge and is more experienced will have more subsidy to underlie his reasoning. Also, it is necessary to know how to interpret information, and the interpretation in general is subjective and related to beliefs and individual education. This is the reason for this proverb: "There are two sides to every question" (Each head, a sentence all the time).
Even so, in order to adequately evaluate a certain issue, it is important to consider different perceptions. It is not easy to accept divergent viewpoints, but if we do our best to, at least, try to understand the meaning of antagonic positions, in a judging commission where none of the members has personal interest in the issue, the result will many times be a reflexive lesson. Reflexive lesson of how the world functions and how people think, besides the possibility of impartial and perfect decision making, which can be applied in a comprehensive way.
Accordingly, to allow a group made up only by researchers to decide what is and what is not correct in scientific experiments with human beings, even if the participants have pretty much good intentions, the evaluation will probably be tendentious and will empower the investigators and not the investigated, the more logical and impartial decisions may look to the group.
This is the reason why one often prefers to make up a judging commission in doctoral thesis, by compounding professors with lines of research similar to the candidate and professors of other subspecialty. And because the super-specialist tends to value very specific aspects of the project and the appraiser who is not a specialist in the area may agree or disagree about notions which could look normal to the subspecialist and inacceptabe from another point of view.
The reasoning is also valid in making up scientific commissions for developing topics to lectures in congresses. In case the commission consists mainly of super-specialists, the level of the scientific program tends to be advanced, for this is the reality of the organizers and, if questioned, they will probably claim that in their experience this is the level of lecture the audience expects. The problem lies in the notion of "in his experience", because although the decision could be correct, when considering his peers, what happens is that a scientific meeting is usually made up by congressists with heterogenious technical knowledge. This distortion can be solved, for example, with a scientific commission made up of super-specialists, generalists and specialists in teaching residents. That is the assurance that all the interests will be considered, for different perceptions will be exposed. In this case, discussions for defining the topics will probably be longer, many times with no consensus; nevertheless, the result will be more impartial from the viewpoint of the several parts involved.
Resuming the discussion about Ethics Commission in Research, the main concern of the appraisers is with the integrity of the research subjects who take over a vulnerable position in the doctor-patient relationship. In the condition of sick people, the research subjects will not refuse invitation from the medical staff to take part in scientific studies. Therefore, the mission of the Commission is to associate the necessity of development of Medicine based in evidences with the preservation of the research subjects. And one of the guarantees that all points of view are considered is the plurality of perceptions and opinions among the participants of the Commission.
References
- 1. Kara-Junior N. A democratização do conhecimento médico e seus desafios. Rev Bras Oftalmol. 2013;72(1): 5-7.
- 2. Chamon W. Paixão, publicação, promoção e pagamento: quais "Ps" motivam os cientistas?. Arq Bras Oftalmol. 2012; 75(2):381-2.
- 3. Rocha EM. Ética em publicações científicas: um trabalho de todo dia - a busca do valor absoluto no mundo relativizado. Arq Bras Oftalmol. 2010; 73(3):217-8.
- 4. Muccioli C. Dantas PE, CamposM, Bicas HE. Relevância do Comitê de Ética em Pesquisa nas publicações científicas. Arq Bras Oftalmol. 2008;71(6):773-4.
- 5. Lois CB, Tavares RS. Direito, deliberações coletivas e limites da racionalidade: uma análise dos fenômenos das cascatas sociais e polarização grupal. Rev Argumenta. 2010;(13):155-67.
- 6. Cavazza N. Psicologia das atitudes e das opiniões. São Paulo: Edições Loyola; 2008.
A importância da diversidade de idéias nas comissões de ética para análise de projetos de pesquisa
Publication Dates
-
Publication in this collection
11 Nov 2013 -
Date of issue
Oct 2013
