NOTICE NOTICIÁRIO
Ethics and epidemiology research and practice
A ética e a pesquisa e a prática da epidemiologia
The debate was held under the auspices of the "Instituto de Medicina Tropical de São Paulo" and the Brazilian Society of Tropical Medicine (SBMT) on April 11, 1991 as a means to contribute to a discussion on Ethics and Epidemiology Liking place on organizations as the International Epidemiology Association (IEA) and the Council for International Organization of Medical Sciences (CIOMS) while the two are in the process of writing guidelines. This debate was also an activity of the committee on Ethies established by the SBMT during its XXVII General Meeting on 1991.
The participants were:
Anamaria C. Schindler, Núcleo de Estudos da Violência/USP.
Guilherme R. da Silva, chairman, Dept. of Preventive Medicine, Univ. São Paulo Medical School.
Maria Carolina S. Guimarães, Dept. of Preventive Medicine, Univ. São Paulo Medical School.
Myriam D. Ribeiro, Dept. of Preventive Medicine, Univ. São Paulo Medical School and Dept. of Preventive Medicine, Escola Paulista de Medicina.
Oswaldo L. Ramos, chairman, Dept. of Medicine, Escola Paulista de Medicina.
Roberto G. Baruzzi, chairman, Dept. of Preventine Medicine, Escola Paulista de Medicina.
Ruth C. L. Cardoso, Dept. of Anthropology, Univ. of São Paulo Faculty of Philosophy, Litterature and Social Sciences, CEBRAPE.
Discussion was centered on the following topics, divided in this summary for practical purposes as: 1 - individual rights, collective rights, conflict and ethics; 2 - autonomy and informed consent; 3 -violence.
Individual rights, collective rights, conflict an ethics
This question was discussed within the framework of human rights of III World subgroups: one urban, with its components of shanty towns and slums and non-urban, isolated communities, in Brazil represented by Indians mainly.
Cultural relativism if taken on its extreme value is a justification for cultural imposition. Although philosophically every culture has the same value as any other or the same right as any other to preserve its values, in everyday life technological development imposes itself as a power over all others; when the extent of power of one society (or culture) is disscussed this should be taken into account. The existence of a more developed technological society makes easier the adoption of its ways of life by less developed ones unless a truly fundamental value exists in a society (or culture) that prevents this.
Health being a fundamental right and being intrinsic to human nature the need for well-being, medical interventions are very rapidly absorbed by a culture. If a medical practice (wich results in well-being) goes against one value of the less developed society conflict is generated and ethical issues arise. This is better exemplified by infanticide still in practice for a number of reasons among a few tribes of the Xingú area although ongoing health care and medical influence in the whole of the Xingú area allows for newborns with congenital defects to survive in less compact tribes of that families raise 7 or 8 children, what was unheard of a few years ago. For some cultures collectives right (s) is (are) a. higher value than individual rights (in constrast to others where collective right is a sum of individual rights) and conflict between one and the other as well as conflict between collective and individual rights may occur if interests or values of different groups within the same society clash or if there is a clash between different cultures. If our ethics with its Jewish-Christian tradition clash with infanticide in a Xingú tribe we must stop to think that ethics, as we understand it is not universal, has also its relativism and the right of a given community to certain practices must be contemplated.
Autonomy and informed consent
Consent bears a straight relationship to information and its nature; information must be such as to put forward to each research subject in a language within his/hers ability to understand all benefits as well as all eventual risk(s) and disconfort (s) involved; this should be done in such a way that ideally the research subject will be as informed as the researcher, the person who knows most about it. Consent mus be given freely an so, it is unethical to use as research subjects inviduals who are confined or submitted to an authority as inmates, recruits or in-patients. Payment to a research subject should never be given as reward or as an excuse for lack of information and only as compensation for time spent. This point is well understood by research subjects in developed countries but in the III World where daily subsistence is often critical it may give rise to enticement of research subjects.
The ability to appreciate information depends on culture and so, it may lead to different behaviors in different cultures, especially in health related issues. However, it is necessary to establish limits to cultural relativism as it has been used to justify violent interventions and lack of respect to other cultures by a dominant power in the past, as done in the past by European empires to its colonies. A cultural relativistic attitude envolves also relationships of power. As each culture has an ethics system it cannot act according to the culture of another but only within its cultural framework and its ethical system; moreover, ethics imposes to each of us limits to some actions but as important as this is for each of us to recognize that the principles we stand by arc not universal and they cannot serve as a reference to us at all instances. If a conflicting situation arises it is necessary to be sensitive enough in order to recogniza if it is necessary to practice cultural relativism, as in the case already mentioned of infanticide among some Xingu tribes.
Violence
Human rights are presently being discussed from a collective standpoint and by categories (if a child is battered this leads to the discussion of the right to protection of all battered children). Modern society discusses politics in a way that allows for discriminated groups, subjects of individual rights, to transform themselves into collective rights subjects. This introduces a new play from a philosophical standpoint between the issues that caused this change and it is precisely this conflict that enlarges and reinterprets ethical limits. This presupposes a permanent negotiation and a clear political play between two collective subjects and not between one collective and another individual subject who should, as an individual, be submitted to an ethics which applies to all individuals.
The matter of urban violence was recognized as a serious problem of the III World by all participants; urban violence is increasing or at least is being better recognized as such in view of ever increasing reports about it. This subject should be a matter of discussion on its Public Health interface by epidemiologists.
Publication Dates
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Publication in this collection
06 Sept 2006 -
Date of issue
Oct 1991
