title: 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.
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.
authors.affiliation: Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: Darlene R
authors.initials: DR
authors.lastname: House
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya.
authors.forename: Irene
authors.initials: I
authors.lastname: Marete
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya Center for Bioethics, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Meslin
mesh_terms: D035843:Biomedical Research / Q000941:ethics; D002986:Clinical Trials as Topic / Q000941:ethics*; D016265:Conflict of Interest; D003220:Conflict, Psychological; D003906:Developing Countries; D026689:Ethical Analysis; D028744:Ethics Committees, Research; D032984:Ethics, Research; D006801:Humans; D007258:Informed Consent; D007630:Kenya; D028681:Moral Obligations; D011057:Politics; D012108:Research Personnel / Q000941:ethics*; D035842:Research Subjects; D013317:Strikes, Employee; D014754:Violence
keywords: Ethics; International Affairs; Research Ethics