Indian Journal of Medical Ethics

THEME: CASE STUDIES IN PUBLIC HEALTH RESEARCH ETHICS FROM INDIA

Ancillary findings during public health research: a researcher’s ethical dilemma

Neethu Suresh

DOI: 10.20529/IJME.2020.016
Keywords: ancillary findings, anticipating research problems, anonymity, protecting participants, public health research

Background

Sometimes researchers investigating one matter come across other issues in the course of their work. Such findings, not directly related to the subject of research, are called ancillary findings. Researchers encountering ancillary findings may face ethical dilemmas on how to act upon these findings.

The case

A researcher was investigating the effectiveness of oral health education on the oral hygiene status of 6- to 12-year-old school children studying in government and government-aided schools in a South Indian state. The researcher conducted focus group discussions with teachers in 16 schools, to understand the dietary habits of children as these can affect their oral health. The participants were promised that the information they provided would be kept confidential and used only for research purposes.

As part of the school meal programme, the government provides lunch and breakfast to school children. School authorities also have the responsibility of providing safe drinking water to the children. During the focus group discussions with teachers, the researcher found that even though care was taken to provide a healthy breakfast and lunch to the school children, not all schools ensured safe drinking water.

Only one out of the 16 schools was taking adequate steps to provide safe drinking water to children throughout the school hours. In each classroom in that school, boiled water was provided in a pot along with a glass, so that children had access to safe drinking water throughout school hours.

In the remaining schools, children faced difficulties in obtaining safe drinking water. In most schools, boiled water was kept in the kitchen, but in some of these schools the kitchen was locked by 3 pm. After 3 pm, children depended on tap water or remained thirsty till they reached their homes. In some schools there was a long distance between the classrooms and the kitchen, so children did not have easy access to safe drinking water.

Rural schools which depended entirely on well water faced water shortages in the summers. In these schools when the power went off they were not able to pump well water. School authorities had therefore instructed children to bring two bottles of water from home, one for drinking and the other for washing their tiffin plates.

The teachers’ justified not providing safe drinking water to the children saying that the children could bring water from their homes, and that drinking tap water does not cause any problems; there was not enough fuel to boil water; it was difficult to carry the heavy water-filled jars from the kitchen to the corridor, and there was a water shortage.

Drinking unsafe water can cause many gastrointestinal problems including vomiting and diarrhoea. Moreover, access to safe drinking water is the right of every child. In schools, it is the responsibility of the school authorities to ensure that children have access to safe drinking water throughout the school hours.

Questions

1. What are the ethical issues at stake here?
2. What is the ethical responsibility of the researcher in this situation?
3. Will the researcher’s ethical responsibilities be different if she is studying the availability of safe drinking water to school children?
4. What are the researcher’s responsibilities when she finds out that ancillary findings contradict government reports?
5. What are the researcher’s responsibilities when media reports question the availability of safe drinking water in schools and the media demands a government level enquiry and action?