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Ciênc. saúde coletiva vol.13 no.2 Rio de Janeiro Mar./Apr. 2008
Methodological procedures and ethical decisions
Procedimentos metódicos e decisões éticas
Franklin Leopoldo e Silva
Department of Phisolophy, University of São Paulo. firstname.lastname@example.org
The article being commented here questions the adequacy for qualitative research of the ethical guidelines established by resolution 196/96 due the positivist paradigm that, according to the authors, would be orienting the mentioned resolution with regard to the profile of scientific research. Furthermore, the presence of this paradigm in a great number of other documents in the field of research ethics would be responsible for the inexistence of appropriate criteria for understanding health research when guided by parameters proper to human sciences.
The subject is immense, not only insofar as the epistemological aspects involved are concerned but also as refers to the scope of the domain of ethics. Before approaching some specific points it seems opportune to call attention to a question of general character.
The knowledge forming the big area defined as Health is quite diversified covering the three great divisions of science: exact, natural and human. As a matter of fact, research into the field of health involves areas ranging from statistical mathematics to the singularity of individual socio-psychological behavior, crosscutting geography, chemistry, biology and others. That being so, there arises the difficulty to configure this diversity in a way that would allow us to refer to it as a whole, a unity, or at least as something sufficiently defined in its possibilities and limitations. For overcoming this difficulty and reaching this relative unity one chooses among the sectors composing the area those with really unquestionable characteristics of scientificity and whose criteria and scientific objectivity are clearly beyond question.
Thus, the choice falls on those research directions whose object or method is offering the typical image of scientific investigation according to standards based on kantism and positivism, considered the epistemological axes composing the modern idea of knowledge. Another contributing factor is that during the period of the methodological constitution of human sciences, most of these criteria were reaffirmed as factors of scientificity, the specificities of the knowledge about the human reality then constructed notwithstanding. The sovereignty of the traditional paradigm, this way strengthened on occasion of the very advent of human sciences, was sometimes criticized, mostly in the philosophical sphere, but not placed in check with a vigor similar to that with which for example the new physics questioned the paradigms of the aristotelic tradition.
As a consequence, the general image of science is still widely based on the positivist paradigm, just the way it was consolidated in the XIX century and refined by the discussions run in the XX century, by the theories of science and by the contributions of the history of sciences. The benchmark thus arising is to such an extent present in the conception of scientific knowledge that it figures as a norm or regulating idea even on the horizon of human sciences, a fact strongly favored by the sciences which, although dealing with aspects of the human reality, are doing this according to entirely positivist theoretical assumptions and operational schemes, economy and a great part of psychology for example. All this results in a variety of problems for qualitative health research. Here we will only highlight two of them, directly or indirectly approached in the commented article.
1. The instrumental character of the objectivist paradigm. It must be repeated that the understanding of modern knowledge contrasts, in Bacon, with the contemplative ideal of the antiquity and the Middle Ages; know the question is knowing nature in order to dominating it and make it serve human purposes. In this sense, technique is not something derived from science or its fortuitous product. Technique is deeply imbedded in the vocation of modern science, is part of its essence. Only from the basis of this inseparability modern science can define itself at the same time as knowledge and domination as dominating knowledge. This instrumental bias manifests clearly in the character of objectivity if we, like Descartes, are to understand the objective as a reality methodically constituted from the representation of the subject, center and building axis of knowledge, technique and ethics, seen as an undissociable whole in the big rational unity of systematic knowledge. The contemporary technological development of the industrial revolution in a certain way already pointed to the reality we are living today, in which a separation of basic science from technological applications is senseless in view of the new unity represented by technoscience.
2. Human Sciences and intersubjectivity. The instrumental character of the objectivist paradigm ought to have raised ethical questions in the field of human sciences if they, since the beginning, had defined themselves as knowledge in which Man is subject and object at the same time. This did not happen due to the dominion of the objectivist paradigm, which in this regard assumed that all knowledge has to constitute itself as subject-object relation. This methodological assumption gave rise to a bifurcation of the subject so that it could also appear as the object of the "Human Sciences", what finds a remote precedence in the Cartesian reflection according to which the subject looks at itself in order to find itself as object. The objectivist theory leveled subject and object under the pretext of separating them methodologically. This is the reason why intersubjectivity remained a philosophical problem: when it comes to seeing it scientifically, intersubjectivity should transform into an objectified phenomenon in a relation objectively exposed to the theoretical vision of a knowing subject.
Thus, given the imperative need of objectivizing the subject, the relation between researcher and researched is never seen as a case of intersubjectivity. The methodological demand for objectivation does not allow a relation of knowledge between two subjects to be established. The ethical implication of this last point seems very clear but, as one can observe, there is an intimate relation with the first, as it were a continuation; the ethical question is present in both and cannot be separated from the epistemological approach. In fact, if the conditions of objectivation in the humanities are to be maintained it would be completely impropriate to define any research involving two subjects as intersubjectivity. In this case however it must be pointed out that - the alternative being the relation subject-object - the vision of the other as object arises as a necessary requirement, and thus the correlated ethical problems will inevitably appear.
The most interesting is that this menace of reification is arising from the humanist ambition to use knowledge for extending the dominion of Man over things. The paradox of humanism consists in the fact that its historical persistence, encouraged by the progress of science and technique, might end up in a vision depriving the human being from its humanity, shall say, completely substituting the subject by the object.
Such effects are not perceived in all their seriousness and ethical extent because they occur first in form of methodological requirements of objective rigor, adherence to which would be natural in a scientific research. Thus, an ethics commission will search in a submitted protocol for those requisites usually considered marks of scientificity and, once identified, the commission will try to find out if the proponents took the precautions necessary in research involving humans, informed consent for example.
The crucial question posed in the article is about what the commissions will not find because they were not looking for it: specific research procedures in an investigation that in no moment considers the human subject an object. In this case the methodological procedures are so to say a continuation of the ethical precautions because none of the phases of the research would have been conceived according to positivist and objectivist criteria. The question raised by the article is if the ethics commissions are prepared for examining projects of this other nature.
This is the reason for the recommendation to revise and amplify the normative resolutions making them contemplate these cases. In this sense, the article points not only to the need for epistemological reflection about the paradigms of scientificity in force but also for ethical reflection reaching beyond a critical examination of this model.
O autor responde
The author replies
The debater's texts are very well written and with a sound basis, which is not surprising considering that they are all experienced authors. As Franklin Leopoldo puts it, [...] our starting point was the acknowledgement that the general image that we have of science is still that of the positivist paradigm, as found in the 19th Century, which is also situated as a norm of regulating idea in the humanistic sciences, by and large including Psychology. We partially agree with this statement, since Psychology was founded as an independent science in the midst of a crisis: how to reach objectivity seen as essential for the production of modern scientific knowledge if this knowledge is produced by an individual with their own subjectivity? How to apply the scientific method planned for the Natural Sciences to the study of subjectivity? Different psychologists have sought several ways of carrying out their pieces of research and have, from the beginning, made explicit two opposing lines of thought: one that believes that challenge lies in the development of a scientific Psychology as per criteria set forth by the Natural Sciences -, and another that understands that Psychology should seek its own methodology, since its object of study is not apprehensible by the former method. The difference found in this search for the most appropriate method, or the method that may be possible for this area is still present at the basis of the many existent schools of thought in Psychology. However, to find out the opinion of "the majority of the" psychologists would require specific study. This statement, nonetheless, leads us to the importance of acknowledging that what is at stake are the different scientific paradigms and not the different professional categories, since, as Franklin points out, there are actually different standpoints even among psychologists. Thus, being within the "Social Sciences and the Humanities" does not guarantee that ideas are shared. Will van den Hoonaard also calls attention to this when he states that there are different ways of defining research and that, for this reason, there are qualitative researchers that do not consider this kind of work a different paradigm. Franklin Leopoldo also states that "[...] modern science can be defined both as knowledge and dominance as dominating knowledge." This power relationship transcends that of nature dominance and is established among humans, thus, the relationship between the researcher and the subject of research is never seen as a case of intersubjectivity since the latter must necessarily be objectified. Objectification as a methodological requirement does not allow for the establishment of a knowledge relationship between two subjects." Franklin Leopoldo brilliantly discusses one of the chore issues at stake, when he points out that the Committees of Ethics in Research - CEPs "[...] will not find specific procedures for research in which the human subject is not, at any time, taken as an object, because they have not sought it." This is indeed a central issue which radically changes the quality of relationship between researcher and researched, and it should be considered in the ethical analysis of these projects, which are already taking the necessary steps to acknowledge and respect the "other" who is involved in the research. Cynthia Sarti also highlights this matter when she refers to the free and informed consent given by the researched, or as she puts it: "The procedure by which the consent is given depends on how the researcher-researched relationship is established and developed [...]". In hierarchical relationships, such as the ones seen in the professional-patient relationship, there can be and there usually is the identification of knowledge and power which, as Cynthia reasons, would lead us to the risk of symbolic violence. Qualitative researches, however, are carried out with human beings, and seek to establish a dialogical relationship.
Rosa Macedo points out the importance of respecting different scientific paradigms due to the fact that the adoption of a method regardless of whether it is qualitative or quantitative must be coherent with the "[...] concept of reality and the knowledge process within that reality." Referring to the "dramatic paradigmatic change established by the cybernetic-systemic approach", she states that "reality can only become knowledge when the subject that perceives it gives it meaning by naming it." Therefore, "the paradigm that supports theory and experimentation is deconstructed, and an intersubjectivity-based alternative is constructed." The need to "objectify" the "object" of study (even if it is a human being) is thus overcome. Now the proposal is that knowledge be produced in this intersubjective locus, which assumes the need for the interaction between at least two subjects. Cynthia Sarti goes along the same direction when she maintains, "if the relationship is not adequately established for both parties, the research per se will not be feasible." This highlights that in such researches, ethical and methodological aspects are intertwined. Margareth Angelo also considers the consent as a process, and that the questions that arise are identified by means of a dialogue that is carefully conducted with sensitivity and respect. These are qualities that cannot be prescribed, controlled or intellectually applied: they must be authentically felt and experienced [...] in the relationship. They emerge within the engagement of the researcher's self with the other (the participant), in mutually respectable manners [...] they are ethically imperative, even if not ethically prescribed; they are learnt in the most fundamental of human experience. For this very reason, if these researches are evaluated merely by their formal aspects such as the written consent term one could consider them not to be in conformity with the Brazilian norms of ethics in research, when, in fact, what happens is precisely the opposite: because the ethical aspects are inseparably incorporated to the researcher's routine, they do not feel the need to record such terms in writing. Or the researcher could even consider that "putting it in writing" would distance the relationship which had been so carefully built with the researched. Therefore, instead of protecting the subject of the research, the procedure jeopardizes the study which might even have been planned with the researched. Thus, unwillingly, the CONEP-CEP system is stepping back when it requires that procedures - which have already been overcome in the kinds of researches discussed here - are followed, on the grounds that deciding the objective and the procedures together with the researched community is much more than requesting consent for taking part in a research designed solely by the researcher. The quality of data collection/generation, as well as their analysis will depend on the relationship established between the researcher and the researched. Besides, the very knowledge validation process will depend on the dialogue between the two parties, besides peer approval. Cynthia Sarti advances when she affirms that: Therefore, in order to validate itself, every scientific area of study is constituted from the dialogue between the researcher and their peers; in Anthropology it is also based on the conditions established in dialogues between researcher and researched. After all, as Will van den Hoonaard reminds us, the forte of qualitative research is its ability to show how the researched understands and experiences their social world which will lead the researcher to check with the researched if their understanding was adequate.
In the context in which the researched is not an "object" of study, and in which the researcher is, as Will van den Hoonaard points out, part of the produced knowledge, the researcher has the sole responsibility over their own acts. Rosa Macedo restates Ravn's proposal and claims "unity and diversity" as ethical principles, both expressing "distinct, yet complementary moments". She concludes that "[...] the problem is established when one (unity or diversity) is carried out to the total detriment of the other (unity or diversity)."
Along the same line, Cynthia Sarti considers that the problem is the "hegemony of one over the other", which is what happens in Resolution 196/96 and its complementary regulations which adopt a research concept referenced in the post-positivist paradigm and claims to be applicable to all types of researches.
The debaters emphasize that qualitative research must be consistent and scientific sound, and must consider the historical backgrounds. It is important to remember Rosa Macedo's words: [...] the planning of any activity aiming at knowledge construction, including research, must adapt to the notion of reality and to the knowledge process of that reality, by using methods that are compatible to such notion so as to have adequate, coherent access to it. This shows that there is no methodology that is hovering in the air. On the contrary, they must be firmly founded in the paradigm that guides the researcher's work, who, in turn, must be coherent with the theoretical frame adopted. Besides, it is also important to say that, although we have focused on qualitative research, there is no intention on our part to dichotomize between qualitative and quantitative methods and techniques, since they can all be used in different paradigms, and even in the same study, bringing important and different information that, when well organized, will contribute to the understanding of phenomena and their complexity. The need for specific guidelines for social and humanistic sciences is grounded on the fact that many of the researchers from these areas adopt interpretative and critical paradigms, which radically differ from the post-positivist paradigm adopted by the Resolution 196/96. We also need to highlight Cynthia Sarti's statement that in the Social Sciences and the Humanities, different paradigms coexist, and this allows for the "coexistence of distinct frames". It would not be the role of the guidelines on ethics in research to establish hegemony of one over others. In fact, this would be ethically inadequate.
We agree with Cynthia when she states that "there is consensus as to the need to normalize research procedures, in their ethical aspects, in all epistemological areas." However, in qualitative researches that are framed within interpretative and critical paradigms, ethics becomes intrinsic to methodological aspects. Thus, the task which the CONEP-CEP system has when analyzing qualitative research would be to verify if they are consistently designed, since the possibility of ethical inadequacies is intimately related to an inconsistent project, possibly designed by researchers whose methodological background was inadequate. This is also the concern put forward by Margareth Angelo when stating that: "The qualitative researcher needs to be solidly educated [...]" As stated by Will van den Hoonaard, when qualitative research migrates from the realm of social and humanistic sciences, and are adopted by other professionals as occurs in the collective health the methodologies themselves are changed. One needs to pay close attention to these changes, to see if they bring new ideas, but maintain internal consistency, or if they were modified with no knowledge of their background. In the analysis of papers that were indexed at MEDLINE1, we identified conflicts that, in actual fact, were a result of lack of clarity from the researcher's part about their own place in the research field a matter so intensely discussed in the Social Sciences and the Humanities, and that might have gone unnoticed by professionals of other areas. To summarize, we can say that there is a lot to explicit on the different notions of qualitative research and about the scope of specific guidelines for the analysis of their ethical aspect.
1. Guerriero ICZ. Aspectos éticos das pesquisas qualitativas em saúde [tese]. São Paulo (SP): Faculdade de Saúde Pública/Universidade de São Paulo; 2006. [ Links ]