Journal of Medical Ethics
January 2016, Volume 42, Issue 1
http://jme.bmj.com/content/current

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Viewpoint
To research (or not) that is the question: ethical issues in research when medical care is disrupted by political action: a case study from Eldoret, Kenya
Darlene R House1,2, Irene Marete2,3, Eric M Meslin2,3,4
Author Affiliations
1Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
2Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
3Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
4Center for Bioethics, Indiana University, Indianapolis, Indiana, USA
Correspondence to Dr Darlene R House, Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; dhouse@iupui.edu
Abstract
While considerable attention has been focused on understanding the myriad of ethical analysis in international research in low and middle income countries, new issues always arise that have not been anticipated in guidelines or studied extensively. The disruption of medical care arising as a direct result of political actions, including strikes, postelection violence and related activities, is one such issue that leaves physician-researchers struggling to manage often conflicting professional responsibilities. This paper discusses the ethical conflicts that arise for physician-researchers, particularly when disruption threatens the completion of a study or completion is possible but at the expense of not addressing unmet medical needs of patients. We review three pragmatic strategies and the ethical issues arising from each: not starting research, stopping research that has already started, and continuing research already initiated. We argue that during episodes of medical care disruption, research that has been started can be continued only if the ethical standards imposed at the beginning of the study can continue to be met; however, studies that have been approved but not yet started should not begin until the disruption has ended and ethical standards can again be assured.