4.5 When Informed Consent is not Required?
General rule says that participants’ valid informed consent is needed for a research study. But sometimes it is impossible to do research if the participants already know that a study is being conducted. Do you think it is sometimes possible to study people without informing them (covert research)?
Read the case below and answer the following question. Would you approve the project?
Case: Covert surveillance of healthcare professionals
Imagine you are member of an ethical committee. The following research project was submitted to you.
Studies have shown that many healthcare professionals in hospital settings do not wash their hands correctly or as often as they should. This is believed to cause infection and illness in a number (possibly a very large number) of patients. A large international project is proposed to evaluate different methods of generating better hand hygiene. These methods include:
- (a) warning healthcare professionals that they might be the subjects of covert video or other surveillance;
- (b) sending healthcare professionals on a training course about hand washing;
- (c) installing additional hand washing troughs;
- (d) offering alcohol-based hand rub facilities as an alternative to conventional hand washing;
- (e) installing ‘extreme signage’ in staff washing areas and toilets (e.g. comparing non-washers to murderers & showing ghastly images of infected wounds).
In general terms, the proposed study will proceed as follows.
- Covert surveillance will be used to establish hand washing frequency baselines for a large number of sites.
- (a)-(e) (above) will then be trialled at selected sites.
- Covert surveillance will be used to assess the effectiveness or otherwise of (a)-(e).
At no point will the consent of healthcare professionals or patients be sought because this would, it is argued, invalidate the study.
The researchers will seek to anonymize the data collected as far as possible by (e.g.) digitally obscuring name badges and faces, and by removing date and place information from video files. They will not feed back information about individual misconduct (e.g. inadequate hand washing) to hospital managers but do reserve the right to report serious criminal activity.
Source of case description: European Textbook on Ethics in Research. Brussels: European Union, 2010.
Assignment
Create a new post in the discussion forum stating: (1) What would be your evaluation of the proposed project? Would you approve this study? (2) What are your arguments for/against carrying out this research without the observed persons’ consents?