Ethical Challenges in Short-Term Global Health Training

Rory is a PhD sociology student working on an eight-week project in an African country. Dr. Hodari, his local advisor, is about to bring up informed consent.  Click image to start video.

CASE 10: Understanding Informed Consent for Research

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Short-term training programs abroad frequently involve research, either as the primary focus of the program or as part of a service project. Conducting research in another country can raise a range of ethical issues.

One of the most important issues a trainee might face arises during the process of informed consent for research. Although widely accepted as a requirement of ethical research, communities around the world have a diverse range of perspectives on informed consent and its ethical justification that rests in respecting individual autonomy.

In this case, we will consider some, though not all, of the challenges trainees, their sending institutions, and host sites, might face during the informed consent process for research.

Consider the following vignette.

Vignette 1: Rory is a PhD student in sociology who is about to embark on an 8-week research project in an African country. He plans to interview women about their experiences in the public health system. Rory has worked closely with his advisor at home, and one in Africa (Dr. Hodari), to develop the project. His home research ethics committee approved his project. Dr. Hodari did most of the legwork in Africa, and assured Rory that the local research ethics committee would similarly give approval by the time he arrived.

Now that Rory has arrived, he is surprised to learn about how “informed consent” is typically obtained in the community in which he is planning to do his research.

Rory’s advisor, Dr. Hodari, has suggested that informed consent for the study will come from the community leaders before the study begins. Which of the following is true about “community consent” for research?

Once the community “consents”, there is no need to approach individuals for consent, if that is what is customary in a particular setting.
This is incorrect. Engaging the community in this way should not replace the decision of individuals regarding participation. Choose a different answer.
"Community consent" is useful but does not replace the choice an individual should have to participate in a research study.
This is correct. “Community consent” is better described as "community approval" or "community agreement", as it cannot replace an individual’s consent. However, the process of approval or agreement can be useful as part of community engagement.
The "community consent" process described by Dr. Hodari has little value.
Even if "community consent" does not truly exist, the process of engaging community leaders is likely to be useful for other collaborative reasons. Choose a different answer.
Before conducting the project, Rory will now need to develop a "community consent" form and have it approved by the research ethics committee.
Although substantive changes to research will require informing both the ethics committee at his home institution and the local ethics committee, this is not the best answer. Choose a different answer.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)