Ethics and Evidence

Au nord de Homs, région de Al-Houleh. Un convoi conjoint du CICR, du Croissant-Rouge Arabe syrien et des Nations Unies se rend dans plusieurs villages où il achemine des vivres, des médicaments et du matériel d'approvisionnement en eau pour plus de 70, 000 personnes.
North of Homs, Al Houleh region. A joint convoy of the ICRC, the Syrian Arab Red Crescent and the United Nations reach several villages to deliver food and water supply equipment for more than 70, 000 people.
Communiqué de presse sur le site web du CICR, 23.03.2016 : « Syrie : des secours parviennent enfin à plus de 70 000 personnes dans la région d’Al-Houleh. [...]. « La population d'Al-Houleh vit depuis longtemps dans des conditions très difficiles », a déclaré Majda Flihi, cheffe du bureau du CICR à Homs, qui a dirigé l'équipe du CICR à Al-Houleh. « Principalement agriculteurs, les habitants ne peuvent plus cultiver leurs terres, et leur bétail ne peut plus être nourri correctement parce que les champs sont aujourd'hui des lignes de front. » Le convoi de 27 camions transportait des vivres, du matériel pour réparer le système d'approvisionnement en eau, ainsi que des secours médicaux visant à soutenir la structure médicale du Croissant-Rouge arabe syrien, durement mise à l'épreuve, dans le village de Kafr Laha. Une équipe d'ingénieurs eau du CICR s'est aussi employée à améliorer l'état des puits qui constituent le seul approvisionnement régulier en eau potable. Un deuxième convoi, prévu dans les prochains jours, transportera des générateurs et des équipements pour assurer l'approvisionnement en eau. « Comme dans tous les lieux assiégés en Syrie, les civils tentent de survivre avec leurs maigres ressources. Ils ont besoin d'un approvisionnement régulier en vivres, en médicaments et autres types d'aide. Il nous faut un accès régulier, quelle que soit la situation sur le terrain », précise Mme Flihi. Al-Houleh vit en état de siège depuis 2012, et est le théâtre de violents combats depuis des mois. La récente accalmie des hostilités a permis aux organisations humanitaires d'accéder dans cette zone. La semaine dernière, un autre convoi conjoint du CICR, du Croissant-Rouge arabe syrien et des Nations Unies a acheminé des vivres et des assortiments d'articles d'hygiène à plus de 60 000 personnes vivant dans les zones assiégées de Madaya, Zabadani, Foua et Kifraya. »
News release on ICRC website, 23.03.2016 : « Syria: First aid in months reaches over 70,000 people in the central Syrian region of Al Houleh. [...] "People in Al Houleh have been facing severe hardship for a long time," said the ICRC's head of office in Homs, Majda Flihi, who led the ICRC team into Al Houleh. "They are farmers but they cannot farm anymore. They have livestock but it cannot be fed properly as peoples' fields have now become front lines."The 27-truck convoy carried food, equipment to repair the water supply and medical aid to support the overstretched medical facility operated by SARC in the village of Kafr Laha. An ICRC team of water engineers also worked on trying to improve the state of boreholes which provide the only steady supply of clean water. A second convoy, planned for the coming days, will bring generators and technical equipment to ensure the water supply. "As in all besieged places in Syria, civilians are trying to survive on meagre resources. They are in need of regular food supplies, medicine and other kinds of aid. We need regular access regardless of the situation on the ground," said Ms Flihi. Al Houleh has been under siege since 2012 and has been the scene of heavy fighting for months. The recent lull in fighting has allowed humanitarian organizations to access the area. Last week, another joint convoy from the ICRC, SARC and UN delivered food and hygiene items to more than 60,000 people living in the besieged areas of Madaya, Zabadani, Foua and Kifraya. »

See also: Ethics and Evidence – Reply to Donal O’Mathuna

The importance of evidence to guide humanitarian action is increasingly recognised. Evidence Aid aims to promote an evidence-based approach to humanitarian work, and to provide evidence to guide decisions about humanitarian aid. That can be seen as a rational, scientific approach to humanitarian action. So what has ethics to do with evidence? My view is that ethics contributes to evidence in at least three important ways.

In the first place, a commitment to using the best evidence to support decision-making in any field is an ethical commitment. Ethics is about doing the right thing for people and promoting what is best for them. Well-intentioned humanitarian interventions have been criticised when their outcomes are not beneficial or they have unintended adverse effects. An evidence-based approach is an important way to improve the chance that interventions and policies are effective and safe. Evidence-based approaches help in accurately identifying the needs of those to be helped, and whether there are political, cultural, religious or ethical concerns about how those needs might be met. The alternatives to evidence are methods based on tradition, authority or power, and those more easily slip into unjust approaches.

The second place where ethics engages with evidence is in the generation of evidence. Evidence-based decision-making requires good evidence which generates a need for high-quality research studies. The best way to show whether one intervention is more effective than another is to conduct a controlled study comparing the two interventions. Ethics should be infused throughout the design of such studies. For example, a study to determine the effectiveness of a new Ebola vaccine raises different ethical issues compared to one seeking to explore the best ways to counsel abused women in refugee camps. While different methodological and ethical issues will arise, some sorts of ethical issues will always exist. Some may be so significant that the study ought not to be conducted in a particular way, in a particular place, or at a particular time. For reasons such as this, ethics must be considered as soon as the research is being conceptualised. When research is being conducted across different cultures, the local community should be consulted right away so that ethical issues are identified and addressed appropriately. Some evidence-generating projects may need to be ethically approved by a research ethics committee. Even if not, the way the project is conducted raises on-going ethical issues that require attention from both researchers and those overseeing the projects. Projects will be carried out to the highest ethical standards only if those carrying them out are personally committed to ethical virtues like honesty (to the data), compassion (to the participants), and justice. The current emphasis on research integrity highlights the need for researchers to be ethical in all phases of research.

The third way that ethics engages with evidence relates to the motivational basis for humanitarian action. Modern ethics has become very much a branch of philosophy and a purely rational enterprise. Criticisms have been raised that ethical analysis leads to opposing conclusions that leave people with the sense that any option is legitimate. Another criticism is that people might know the right thing to do and yet not do it. For example, news reports might show the terrible conditions people experience after disasters or protracted conflict. Viewers may say to themselves that the right thing is to help those people, maybe by donating to a reputable charity. Yet five minutes later they have forgotten about the people they saw, and spend their extra cash on a night’s entertainment.

Ethics is about thinking through the ethical dilemmas we face. It includes the rational analysis of ethical arguments. Ethics also includes the emotional and motivational aspects of decision-making. This is where ethics becomes very personal. Ethics is about our hearts as well as our heads. If we believe that telling the truth is right, ethics includes having the courage to speak the truth when fudging a few facts would be more convenient. It means defending the rights of those participating in research or receiving aid, even when that is more difficult or time-consuming. It means upholding the dignity of all people, even if ignoring a “little” violation would be easier. In this way, ethics infuses all of our decisions and needs to be given careful consideration and heartfelt attention at all times.

Donal_ÓMathúnaDr Donal O’Mathuna is Senior Lecturer in Ethics, Decision-Making & Evidence at Dublin City University, Ireland, Chair of COST Action IS1201: Disaster Bioethics, and Convenor of Cochrane Ireland.

Add yours ↓
  1. Neil Pakenham-Walsh

    I would like to add a fourth ethical dimension: The ethics of making evidence available to those who need it.

    This includes (but is not limited to) the ethics of restricted-access versus open-access publishing. Where information is needed to save life or reduce suffering, there is an ethical case that those who are involved in generating and publishing such evidence have an ethical responsibility to make the information available to those who need it.

    For any given piece of information/research, those researchers/publishers who decide to publish this information open-access are largely meeting their ethical responsibility to make essential information freely available (and also freely reproducible and built-upon). Those who decide to publish restricted-access include some where they have no choice and some where there is a choice. Increasingly, and arguably for the vast majority of research, open-access publishing *is* a realistic option for authors. Those who shirk the open access option (for example, because they seek to publish in a high-impact-factor restricted-access journal, motivated by their personal career aspirations) have ethical questions to answer.

    Neil Pakenham-Walsh, Healthcare Information For All,

    August 24, 2016
  2. Donal O'Mathuna

    Neil adds an important fourth ethical issue. I’m sure there are more, so it would be great to have others contribute the ethical issues they see in this area.
    I agree with Neil’s general point, but as Hugo pointed out in his blog, there are often other ethical components that have to be balanced. This is where ethical reflection is an on-going responsibility to ensure the particulars of each situation or case are carefully considered. Information that can save lives or reduce suffering clearly should be available open-access. It should also be made available in a timely way, balancing the need for information against the importance of accuracy and review.
    But there can be other issues to be considered that might lead to some restrictions in access. A couple of examples come to mind, but I’m sure there are others that people might suggest. The dual use dilemma has received much attention in recent years with biological research. Publishing all the information on a virus, for example, could make it easier for it to be used in biological warfare. Does this justify restricting the information to certain scientists or organisations? With qualitative research, the security of participants might be put at heightened risk through open access. Might this justify limiting access to certain organisations? Restricting life-saving research results for reasons like personal ambition and career advancement is not ethical in my book. But there can be other issues that need to be considered with specific types of research that make one approach to ethical publishing unlikely.
    Thanks for raising this issue, Neil.

    September 9, 2016