Ethical Concerns in International Nursing Research

Developing countries have been subjected to exploitative behaviours by other countries, business enterprises as well as individuals. Less than full strength drugs have made their way into these countries, as have capsules altogether empty of medication. Similarly, human subject protection abuses that would not be tolerated in developed countries have been practised on unsuspecting persons. These types of abuses may be occurring, in part, due to a lack of expertise, or a lack of regulatory or governmental infrastructures in developing countries, and insufficient monitoring of practices and behaviours on the part of companies and individuals from their own countries. Therefore, nursing needs to be sensitive to these realities. In undertaking international research with human subjects, the principles of respect for persons, beneficence and justice should apply as they do in the investigator's country. The manner in which they are applied may need to be modified to be appropriate to local regulations, customs and prevailing norms. Advice should be obtained from relevant authorities or community leaders. The issue of monetary compensation can be thorny, especially if it is of a magnitude that induces the poor to participate, as this introduces a systematic bias into the study and can be seen as exploitative. It has been suggested that compensation focus on costs incurred in participation, and not be mentioned until after consent has been obtained. 1 Ethical quandaries of international work revolve around inequalities and differences across countries. Some of these are: unequal power, cultural, religious and moral differences in societal goals, differing conceptions of health and its significance, potential for competition with local providers, accountability of science and potential for creating dependency. 1 Two recommendations are presented: (ii) all individuals planning to do research in international settings engage in an intensive study of the country and setting to be visited; and (ii) we consider an international forum within which some ethical guidelines might be developed. As a step in this direction, individuals interested in dialogue on the subject are invited to contact the author ( Ketefian@umich.edu). An email group will then be created for dialogue. Discussion results will be placed on a web site.