http://dx.doi.org/10.24016/2022.v8.314
REVIEW
PAPER
Ethical implications
in the evaluation of complex contexts related to COVID-19
Implicancias éticas en la evaluación de
contextos complejos relacionados al COVID-19
Anthony Copez-Lonzoy 1, Ana Lucía Vilela-Estrada 2,3,
G.J Meléndez-Torres 4
1 Unidad de investigación en bibliometría,
Universidad San Ignacio de Loyola, Lima, Peru.
2 Instituto Peruano de Orientación Psicológica,
Lima, Perú
3 CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad
Peruana Cayetano Heredia, Lima, Peru.
4 Faculty of Health and Life
Sciences, University of Exeter, United Kingdom.
* Correspondence: anthonycopez22@gmail.com.
Received: October 29, 2022 | Revised: November 30, 2022 | Accepted:
December 28, 2022 | Published online: December 28, 2022.
Copez-Lonzoy, A., Vilela-Estrada, A. L., & Meléndez-Torres,
G. J. (2022). Ethical implications
in the evaluation of complex contexts related to COVID-19. Interacciones, 8, e314. http://dx.doi.org/10.24016/2022.v8.314
ABSTRACT
Background: The pandemic caused by
Sars-cov-2 has generated multiple sustained efforts for its identification,
characteristics and mobility of the disease that to date has repercussions
worldwide. Given this need, it is necessary to have updated information
considering transparent research processes. Method: a
critical review of the current literature on COVID-19 research. Conclusions: It is essential to have
ethical procedures in the different phases of research that can go beyond
personal interests and that guarantee the preservation of people's welfare in
the reduction of possible damage to health globally, adequate procedures in the
collection of information that is not built to the measure of the researchers,
to avoid involuntary segregation of the participants and that this leads to a
reduction of significant damage due to implicit biases that are generated by
poor planning that pursues the scoop instead of social good.
Keywords: Ethical aspects; SARS-Cov
2; Research report; Evaluation Process Assessment.
RESUMEN
Introducción:
La pandemia ocasionada por el Sars-cov-2 ha genero múltiples esfuerzos
sostenidos para su identificación, características y movilidad de la enfermedad
que hasta la fecha tiene repercusión a nivel mundial y ante esta necesidad es
necesario contar con información de actualiza teniendo en cuento procesos
claros de investigación. Método: revisión crítica del cuerpo
actual de literatura sobre investigación en COVID-19. Conclusiones:
Es imprescindible contar con procedimientos éticos en las diferentes
fases de investigación que puedan ir más allá de los intereses personales y que
garanticen la preservación del bienestar de las personas en la reducción de
posibles daños en la salud de manera global, adecuados procedimientos en la
recolección de información que no se encuentren construidos a la medida de los
investigadores, para evitar una segregación involuntaria de los participantes y
que esto conlleve en una reducción de daños significativos por sesgos
implícitos que son generados por una mala planificación que persigue la
primicia en lugar de un bien social.
Palabras clave: Conducta ética; SARS-Cov 2; Informe de investigación; Evaluación de procesos.
BACKGROUND
In recent years, the growth and emergence of emerging diseases have
generated a series of complications with enormous repercussions worldwide. A
concrete example is the report of the three most recent major coronavirus
epidemic outbreaks (Baric, 2008; Qiu et al., 2018);
the first was caused by severe acute respiratory syndrome associated with
coronavirus (SARS-Cov), which managed to spread
through 26 countries between 2002 and 2003 generating painful public health
emerging crises and significant impact on health, society and economy (Qiu et al., 2018; Reina & Reina, 2015). A decade later,
the Middle East respiratory syndrome-associated coronavirus (MERS-CoV) was identified, affecting 27 countries in the Middle
East, Europe, North Africa and Asia (Altmayer et al.,
2021); finally, the current pandemic originated in Wuhan (China) in December
2019 by the acute respiratory syndrome (SARS-Cov 2)
of the same pathogen family that to date reports more than 4 million cases in
210 countries and 300 thousand deaths worldwide (Arshad Ali et al., 2020;
Greene et al., 2020). Given this situation, sustained efforts have been
generated by various research groups and researchers to try to identify the
clinical characteristics of infected patients, the genomic characterisation
of the virus, and the challenges for global health governance (Wang et al.,
2020); in addition to the need for studies aimed at mitigating the implications
and social effects corresponding to a pandemic-related condition (e.g. social
isolation) (Salazar & Abrahantes, 2018; Xiang et
al., 2020).
Therefore, an ethical basis is essential to ensure that such studies have
as their primary objective the well-being of people, society and the ecosystem
(The Belmont Report | HHS.gov, 1979) responding to the different needs and
circumstances generated by the context of COVID-19. To ensure this premise
since 1979 (Belmont Report), three basic principles of ethical research
practice living beings have been established and governed to this day: respect,
beneficence and justice (García & Contreras, 2016; Salazar & Abrahantes, 2018). These premises foster collaboration,
cooperation and trust among scientists; and benefit the correct approach to
objectives, the fulfilment of social responsibility and the minimisation
of harm in research (Aristizábal Franco, 2012).
The global scenario under the pandemic scenario demands the production
and dissemination of information on the disease and its social and economic
implications (Baric, 2008). However, this activity may be affected by ethical
problems linked to the ideals of authors, processes and research results in
developing knowledge (Aristizábal Franco, 2012). In this way, a study can be manipulated for particular
benefits as a result of interests unrelated to the scientific endeavour damaging the neutrality of the researcher
driven by other types of motivations related to personal recognition, obtaining
economic benefits and substantive promotions, forgetting the general function
which is to give answers to society (Aristizábal
Franco, 2012; Kohrt et al., 2019). One way to
mitigate them converges with the conformation of experienced work teams, which
guarantee to some extent the progress and success of studies based on clear and
normative policies that avoid exposing study subjects to physical and mental
complications (Aristizábal Franco, 2012; Salazar
& Abrahantes, 2018; Wang et al., 2020); and,
avoiding as much as possible improvisation (e.g. little experience of most of
its actors), which by their formative characteristics often lack clear lines of
research and inefficient structuring of projects, which reinforce the usual
practice of superfluous publications, often associated with the well-known
Publish or Perish at the industrialised level (Holmes
et al., 2020). However, there is an undeniable need for new evidence
linked to new diseases, data collection from a multidisciplinary perspective
and the urgency of gathering further information with social benefits (WMA -
The World Medical Association - WMA Helsinki Declaration - Ethical Principles
for Medical Research Involving Human Subjects, 2011).
Another consideration to detail is what is stated in the Declaration of
Helsinki (Ibeas et al., 2019), where it is stipulated that all research protocols must
be evaluated by ethics committees, which will be responsible for overseeing the
ethical principles and the determination of the possible value of the study
considering the scientific validity, methodology, participant selection
processes, the balance of foreseeable risks, the benefits of the work under
analysis and ensuring the valuation of the participants in decision-making
regarding their participation through essential aspects such as informed
consent, confidentiality, autonomy and freedom of the participants in all
research processes (Ticse et al., 2014). However, in
Low- or Middle-Income countries, the early stages of the emergence and spread
of the disease only began with the first phase of review of the research work
by an ethics committee (Benito-Cóndor et al., 2016; Nosek et al., 2002), which, together with the urgency of
knowledge, configures a risk that would make possible the contamination of the
actual need for knowledge that benefits the participants involved and prioritises the individualised
need of the researcher.
The COVID-19 containment measures had social distancing as the central
axis, given the need for data collection to answer the various research
questions, leading to determining virtual means as the preferred data
collection strategy through the use of online surveys (Aristizábal
Franco, 2012). This methodology should have all the necessary ethical
requirements to ensure that the study results do not consider a significant
burden of biases, nor are they constructed to suit the researchers. In this
sense, three essential differences can be identified in face-to-face vs.
virtual research: (a) The absence of a responsible or trained research staff,
with whom the subjects of a study can contact to resolve their doubts and
identify their rights as participants in real time (Trachsel
et al., 2021); (b) the uncertainty about informed consent, a position that puts
at risk the understanding of the study, the possible specific benefits and
their consequences, as well as the explanation about the voluntariness and the
absolute freedom of participation of the study subjects (Boileau et al., 2018;
The Belmont Report | HHS.gov, 1979; Trachsel et al.,
2021); and (c) the potential loss of anonymity and confidentiality, because
target participants must register their interest in the research and must enter
other data and personal information and in addition, it will be necessary to
identify website security regulations regarding data encryption and firewalls
(Espinosa, 2016; Nunan et al., 2018; Trachsel et al.,
2021).
In contrast to all of the above, there still needs to be a convincing
detailed distribution of the possible benefits of the target populations
referred to in studies on the effects of social isolation in the face of the
pandemic caused by COVID-19 (e.g. behavioural
research). Possible risks to be taken into account would be linked to the
segregation of participants, differences in the impact of these conditions on
the general population, patients with psychiatric problems, the elderly, and
chronic diseases, among other vulnerable groups that should be adapted to
particular needs. In addition to some "holes" before the emergence of
more evidence on COVID-19 and its variants, the mismanagement of communication
with sensationalist perspectives on sensitive issues may incur an ethical fault
in itself (Goyal et al., 2020; Reger et al., 2020;
SPI-B, 2020).
Sustained efforts encourage researchers to attempt to approximate
responses in the face of complex contexts such as the current pandemic.
However, these benefits can be significantly reduced by a set of biases (e.g.
selection and affinity) influenced by lack of control and non-planning (online
surveys), which can be considered offensive or as an unwanted publication
"spam" or an invitation for the development of a study without prior
agreement (Nunan et al., 2018). The generation of an erroneous estimate in
selecting participants would lead to wrong conclusions affecting the validity
of future results (selection bias) (Aarons, 2017). In addition, risk factors
linked to the participation of studies with this methodology should be considered,
considering the balance in need for data collection and exposure to physical,
emotional and/or social harm that can be generated in the participants and how
to address the risks to which the participants were exposed: for example, the
risk of suffering psychological damage as unfavourable
or altered states in behaviour when associated with
distressing events, when analysing various aspects of
their life and environment or if the participants feel threatened or stressed
as a result of the research (Aarons, 2017; Wright, 2005). Despite this, the usefulness of this input is
well accepted due to its low cost and quick access to different target
populations (adolescents, young adults, working staff, and social isolation,
among others) (Nunan et al., 2018; Wright, 2005). The generation of an erroneous estimate in
selecting participants would lead to wrong conclusions affecting the validity
of future results (selection bias) (Aarons, 2017).
Added to this point, the affinity generated by the researcher in his network
of contacts (e.g. social networks) configures a bias in itself due to the
emotional charge associated with the responses influenced by the researcher
and, consequently, the overestimation in the raw scores in the generation of
new systematic errors.
The current pandemic includes a series of complications at different
levels, including an impact on the economy, health and society in general. For
this reason, effective and efficient responses must emerge through scientific
research as a reliable means of information and communication. This activity
must be fully compatible with ethical behaviour that
pursues freedom and autonomy along with clear benefits for the participants
and, above all, for the social good. It is necessary to avoid that scientific
work can be influenced by ideals that go beyond the expected benefit and can
promote unethical behaviours, massifying the
information without generating a real contribution to the scientific community.
Despite the need for updated knowledge, it is essential to consider different
strategies for collecting and caring for data confidentiality. To a certain
extent, behaviour research has preferred virtual data
collection forms, but without adequate planning. It incurs a series of
complications due to the generation of new biases in the results, a biased
awareness of informed consent and voluntariness, added to a potential loss of
participants, accumulating a chain of contamination of the studies that do not
include in detail the implications of the study groups (according to their
context) such as psychiatric patients, emotional problems, addictive behaviours and the general population, among other
vulnerable groups that by their nature could hinder the processes of adaptation
to restriction measures due to social distancing in the face of the current
pandemic. Consequently, the possible benefits of the results could translate
into potential harm due to the lack of double goodness, which implies doing
something good and doing it well. It is necessary to consider regulatory
processes and procedures in scientific activity and practice as a public good,
which requires bringing to light these reciprocal factors and avoiding the
ethical horrors committed in the past.
ORCID
Anthony Copez-Lonzoy https://orcid.org/0000-0003-4761-4272
Ana Lucía
Vilela-Estrada https://orcid.org/0000-0001-5647-465X
G.J Meléndez-Torres https://orcid.org/0000-0002-9823-4790
AUTHORS' CONTRIBUTION
Anthony Copez-Lonzoy: Conceptualization, Investigation, Writing -
Original Draft.
Ana Lucía
Vilela-Estrada: Conceptualization, Investigation, Writing - Original
Draft.
G.J Meléndez-Torres: Conceptualization, Investigation,
Writing - Review & Editing.
FUNDING SOURCE
Nuestro estudio ha
sido autofinanciado.
CONFLICT OF INTERESTS
The authors declare
that there were no conflicts of interest.
ACKNOWLEDGMENTS
Not applicable.
REVIEW PROCESS
This study has been
reviewed by external peers in double-blind mode. The editor in charge was C Mahony Reátegui-Rivera. The review process is included as
supplementary material 1.
DATA AVAILABILITY STATEMENT
Not applicable.
DISCLAIMER
The authors are
responsible for all statements made in this article.
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