Ethics and evidence

See also: Ethics and Evidence – Reply to Donal O’Mathuna

The importance of evidence to guide humanitarian action is increasingly recognised. Evidence Aid aims to promote an evidence-based approach to humanitarian work, and to provide evidence to guide decisions about humanitarian aid. That can be seen as a rational, scientific approach to humanitarian action. So what has ethics to do with evidence? My view is that ethics contributes to evidence in at least three important ways.

In the first place, a commitment to using the best evidence to support decision-making in any field is an ethical commitment. Ethics is about doing the right thing for people and promoting what is best for them. Well-intentioned humanitarian interventions have been criticised when their outcomes are not beneficial or they have unintended adverse effects. An evidence-based approach is an important way to improve the chance that interventions and policies are effective and safe. Evidence-based approaches help in accurately identifying the needs of those to be helped, and whether there are political, cultural, religious or ethical concerns about how those needs might be met. The alternatives to evidence are methods based on tradition, authority or power, and those more easily slip into unjust approaches.

The second place where ethics engages with evidence is in the generation of evidence. Evidence-based decision-making requires good evidence which generates a need for high-quality research studies. The best way to show whether one intervention is more effective than another is to conduct a controlled study comparing the two interventions. Ethics should be infused throughout the design of such studies. For example, a study to determine the effectiveness of a new Ebola vaccine raises different ethical issues compared to one seeking to explore the best ways to counsel abused women in refugee camps. While different methodological and ethical issues will arise, some sorts of ethical issues will always exist. Some may be so significant that the study ought not to be conducted in a particular way, in a particular place, or at a particular time. For reasons such as this, ethics must be considered as soon as the research is being conceptualised. When research is being conducted across different cultures, the local community should be consulted right away so that ethical issues are identified and addressed appropriately. Some evidence-generating projects may need to be ethically approved by a research ethics committee. Even if not, the way the project is conducted raises on-going ethical issues that require attention from both researchers and those overseeing the projects. Projects will be carried out to the highest ethical standards only if those carrying them out are personally committed to ethical virtues like honesty (to the data), compassion (to the participants), and justice. The current emphasis on research integrity highlights the need for researchers to be ethical in all phases of research.

The third way that ethics engages with evidence relates to the motivational basis for humanitarian action. Modern ethics has become very much a branch of philosophy and a purely rational enterprise. Criticisms have been raised that ethical analysis leads to opposing conclusions that leave people with the sense that any option is legitimate. Another criticism is that people might know the right thing to do and yet not do it. For example, news reports might show the terrible conditions people experience after disasters or protracted conflict. Viewers may say to themselves that the right thing is to help those people, maybe by donating to a reputable charity. Yet five minutes later they have forgotten about the people they saw, and spend their extra cash on a night’s entertainment.

Ethics is about thinking through the ethical dilemmas we face. It includes the rational analysis of ethical arguments. Ethics also includes the emotional and motivational aspects of decision-making. This is where ethics becomes very personal. Ethics is about our hearts as well as our heads. If we believe that telling the truth is right, ethics includes having the courage to speak the truth when fudging a few facts would be more convenient. It means defending the rights of those participating in research or receiving aid, even when that is more difficult or time-consuming. It means upholding the dignity of all people, even if ignoring a “little” violation would be easier. In this way, ethics infuses all of our decisions and needs to be given careful consideration and heartfelt attention at all times.

Dr Donal O’Mathuna is Senior Lecturer in Ethics, Decision-Making & Evidence at Dublin City University, Ireland, Chair of COST Action IS1201: Disaster Bioethics, and Convenor of Cochrane Ireland.