Ethical Challenges in Short-Term Global Health Training

Dr. Hodari explains that in the community the husband gives the formal consent though they speak with both the husband and the wife. Click image to start video.

CASE 10: Understanding Informed Consent for Research

Vignette 2: After asking Dr. Hodari about "community consent," Rory realizes he misunderstood: Dr. Hodari meant engaging the community leaders to agree that the research could begin - not that they would "consent" for all their members.

As Dr. Hodari and Rory prepare to begin the informed consent process for their first interview, Dr. Hodari casually mentions a complicating factor.

In this vignette, Dr. Hodari informs Rory that the husband “will give the formal consent” for the research interview. Rory is again confused. In his country, only the individual can give consent. How might we best understand, ethically, Dr. Hodari involving a family member in the consent process?

A. It is never permissible to involve a family member in the consent process. Rory should not proceed.
In some cases, involving a family member in the decision making process can be acceptable. Indeed some participants might ask for this. Involvement, however, cannot replace an individual’s consent. Only rarely can a family member’s permission supplement individual consent; discussing this is beyond the scope of this case. Choose a different answer.
B. "Formal consent" might be ceremonial or symbolic, but it cannot replace individual informed consent.
This is correct. Individual consent remains paramount to the ethical conduct of research abroad. If Dr. Hodari means that the husband’s "formal consent" is merely ceremonial or symbolic, this might be acceptable.
C. If husbands consent for wives in particular communities, then the consent process should be directed towards them.
The consent process should not be directed toward anyone other than the research participant. In rare cases permission might be sought from family members to approach subjects, but individual consent remains central. Choose a different answer.
A and B.
Only one of these is correct. 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)