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Emergency care research ethics in low-income and middle-income countries
  1. Joseph Millum1,2,
  2. Blythe Beecroft2,
  3. Timothy Craig Hardcastle3,
  4. Jon Mark Hirshon4,
  5. Adnan A. Hyder5,
  6. Jennifer A. Newberry6,
  7. Carla Saenz7
  1. 1Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
  2. 2Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
  3. 3Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
  4. 4University of Maryland School of Medicine, University of Maryland, Baltimore, MD, United States
  5. 5Milken Institute School of Public Health, George Washington University, Washington, DC, USA
  6. 6Stanford University School of Medicine, Stanford University, Stanford, CA, USA
  7. 7Regional Program on Bioethics, Department of Health Systems and Services, Pan American Health Organization, Washington, DC, United States
  1. Correspondence to Dr Joseph Millum; millumj{at}cc.nih.gov

Abstract

A large proportion of the total global burden of disease is caused by emergency medical conditions. Emergency care research is essential to improving emergency medicine but this research can raise some distinctive ethical challenges, especially with regard to (1) standard of care and risk–benefit assessment; (2) blurring of the roles of clinician and researcher; (3) enrolment of populations with intersecting vulnerabilities; (4) fair participant selection; (5) quality of consent; and (6) community engagement. Despite the importance of research to improve emergency care in low-income and middle-income countries (LMICs) and the widely acknowledged ethical challenges, very little has been written on the ethics of emergency care research in LMICs. This paper examines the ethical and regulatory challenges to conducting emergency care research with human participants in LMICs. We outline key challenges, present potential solutions or frameworks for addressing these challenges, and identify gaps. Despite the ethical and regulatory challenges, conducting high-quality, ethical emergency care research in LMICs is possible and it is essential for global health.

  • emergency care
  • ethical emergency care research
  • research ethics

This is an open access article distributed under the terms of the Creative Commons Attribution Non commercial IGO License (https://creativecommons.org/licenses/by-nc/3.0/igo/), which permits use, distribution, and reproduction for non-commercial purposes in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that PAHO or this article endorse any specific organization or products. The use of the PAHO logo is not permitted. This notice should be preserved along with the article's original URL.

https://doi.org/10.1136/bmjgh-2018-001260

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors All authors were part of the conception of the paper. JM and BB compiled the regulations. JM drafted the paper. BB, TCH, JMH, AH, JAN and CS provided technical and regulatory information, case studies and revised the paper.

    • Funding This work was partly supported by the intramural program of the Fogarty International Center, National Institutes of Health, USA.

    • Disclaimer The ideas and opinions expressed are the authors’ own. They do not necessarily represent any official position or policy of the US National Institutes of Health, the US Department of Health and Human Services, the Pan American Health Organization, the WHO or any other institutions with which authors are affiliated.

    • Competing interests JMH is Vice President of the American College of Emergency Physicians. The authors otherwise declare no competing interests.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.