Skip Navigation

School Accolades

Navigating Ethical Quandries in the Field

Maria MerrittWhat is the right way to treat people? When Maria Merritt, an assistant professor in International Health and core faculty at the Johns Hopkins Berman Institute of Bioethics, digs into data from her studies, that question guides her.

More specifically, she asks of the data, What is the right way to treat the people who participate in community-based public health field trials in low-income settings?

“There’s little, if any, established guidance,” says Merritt, PhD. “If investigators want to do the right thing, they have to figure it out on their own.”

Most of the bioethics work so far applies to the researcher-participant relationship in relatively well-funded clinical settings. Bioethicists provide plenty of guidance on issues such as informed consent and genetic testing. But in a field trial in Bangladesh, for example, the ethical questions that arise look different.

One such question is that of parallel treating. If study workers in a maternal health field trial encounter participants who suffer from injury or malnutrition, should they treat the participants for their co-morbidities? Parallel treatment, or ancillary care, stirs up further quandaries: How much is enough? Could the treatment jeopardize the study? The questions go beyond ancillary care, as well. Study teams sometimes have opportunities to provide benefits for the community at large—chlorinating a well, for example—and have to make decisions about how much to do.

To answer these questions, Merritt and her colleagues Holly Taylor, also a core faculty member at the Berman Institute, and Luke Mullany, assistant professor in International Health, have a project under way.

The team has amassed a body of qualitative data from Bangladesh, Nepal and India. The data consist of feedback from seasoned investigators and senior field directors collected during interviews: The participants relay challenges they’ve experienced in the field and their responses to the problems. Merritt and her colleagues are looking for the common threads.

“You need to know what these experienced practitioners see, what stands out,” says Merritt.

While there are broad ethical guidelines in place for international trials, Merritt would like to focus on operational guidelines for the particular ethical challenges presented by low-resource, low-tech communities, where the study is not taking place in a clinical facility. Her hope is that these guidelines would lead investigators to explore things such as the study site’s local health care infrastructure, existing programs that could do parallel treatment, the population’s burden of disease, and options for referral and collaboration.

“Investigators navigate intuitively through these situations,” says Merritt. “I’d like to connect and document the data we have, which encompasses best practices.”

In part, Merritt’s endeavors will be supported by the Greenwall Foundation, which named her this year’s recipient of the Greenwall Faculty Scholars Program in Bioethics career development award. The award is intended to support early career research among young bioethicists.

design element
Online Extras

Expanding Mental Health Care

Expanding Mental Health Care

Researcher Laura Murray explains how inexpensive, effective, science-based care can be delivered where it’s needed most.

Watch Now

Talk to Us

Amazed? Enthralled? Disappointed? We want to hear from you. Share your thoughts on articles and your ideas for new stories:

Download the PDF

Get a copy of all Departments articles in PDF format. Read stories offline, optimized for printing.

Download Now (380KB)