Fundamentalism, Multiculturalism and Problems of Conducting Research with Populations in Developing Nations

Abstract

A growing number of nurse researchers travel globally to conduct research in poor and underserved populations in developing nations. These researchers, while well versed in research ethics, often find it difficult to apply traditional ethical standards to populations in developing countries. The problem of applying ethical standards across cultures is explained by a long-standing debate about the nature of ethical principles. Fundamentalism is the philosophical stance that ethical principles are universal, while the anthropologically-based 'multicultural' model claims the philosophical position that principles are culturally bound. The authors explicate the two philosophical stances and advocate a morally sensitive but moderate position of 'ethical multiculturalism' rather than favouring either of the above philosophical positions. The final section suggests ways to promote ethical multiculturalism while planning and conducting nursing research.

Ethical and practical challenges in implementing informed consent in HIV/AIDS clinical trials in developing or resource-limited countries

“…The lack of public understanding of doctors' and/or of scientific methods' fallibility or limitations (including those of clinical trials') seem to be some of the unresolved cultural issues in AIDS trials; a clash of the scientific culture with the non-expert, traditional culture. Because of cultural barriers, research participants in the developing world might give consent that is uninformed by Western standards (Crigger et al, 2001). Furthermore, patients of the developing world might be intimidated by the authority of the physician and might be afraid to ask questions, or state their unwillingness to participate in the research trial (Karim et al, 1998).…”

“…Recent publications suggest that the informed consent comprehension is enhanced, when study participants are provided with information prior to consent and when study communities are engaged in discussion about research -through counselling, meetings with local leaders or public forums (Crigger et al, 2001;Dickert & Sugarman, 2005;Muthuswamy, 2005). Respecting the community and its values is essential: the research protocol should start and end with the community (Crigger et al., 2001).…”

“…Furthermore, certain principles of individual informed consent may not be in keeping with the cultural norms and practices of non-Western societies (Crigger et al, 2001;Hyder & Wali, 2006;Macklin, 1999;Shaibu, 2007;Zion, 2005(a)). Investigators quickly discover that there is a need to reconstruct the standards of informed consent in the developing world, with full recognition of cultural diversities, cultural preservation and plurality of standards (Crigger et al, 2001;Macklin, 1999;Shaibu, 2007;Zion, 2005 (a)). …”

“…Respecting the community and its values is essential: the research protocol should start and end with the community (Crigger et al., 2001). Woodsong and Karim (2005), based on their experience with the HIV Prevention Trials Network, outlined a full model designed to enhance the informed consent process.…”

“…Current guidelines for research ethics must be modified to include the operational flexibility of applying the informed consent process in resource-limited countries (Crigger et al, 2001;del Rio, 1998;Faden & Kass, 1998;Shaibu, 2007). The application of standards for consent can be daunting for researchers when they face the pragmatic constraints of the field and the reality of cultural beliefs about consent in the developing nations (Crigger et al, 2001;del Rio, 1998;Faden & Kass, 1998;Shaibu, 2007). The implementation of consent in Botswana, for instance, was influenced by several factors: family-centered decision-making, cultural dynamics pertaining to sex, relationship to older persons, and the caregiving arrangement (Shaibu, 2007).…”