Rethinking ethics in qualitative health research
The Brazilian guidelines for the analysis of ethical aspects of research with human beings are set in the National Health Council - CNS Resolution 196/96 and in its complementary resolutions. These resolutions are based on international documents such as the Nuremberg Code, the Helsinki Declaration and the Guidelines proposed by the Council for International Organizations of Medical Sciences - CIOMS, which were developed by medical associations for biomedical, behavioral or epidemiological research. The Resolution 196/96 adopts the research definition found in the CIOMS document (1993), but broadens its scope to research carried out in any area of knowledge. However, in practice, the application of its principles has showed limitations with regard to qualitative research, especially in social and humanistic areas which adopt the interpretative and critical paradigms. Difficulties are seen among investigators and also by the National Commission for Ethics in Research - CONEP and the several institutional Ethics Research Committees - CEPs. Difficulties in terms of analysis and revision have resulted in delays or even in impediment for the development of project.
We consider that the diversity of methods, techniques, paradigms, theoretical frameworks, viewpoints and understandings are essential for the production of new knowledge about an object as complex as health. It is fundamental that the ethics committees may be prepared to review and support the development of research that meet social interests and respect the research participants.
Due to its direct involvement in this theme, the Ethics Research Committee of Health Department of the City of São Paulo - CEP/SMS, in partnership with the Special Program for Research and Training on Tropical Diseases (TDR) sponsored by UNICEF/UNDP/WORLD BANK /WHO, called a meeting in August 2006, with the participation of 30 national and international specialists to discuss ethical aspects pertaining to qualitative research. This thematic issue of Ciência e Saúde Coletiva publishes the five working papers discussed in the meeting by Nunes, Minayo, Concone & Cerveny, van Hoonaard, and Guerriero & Dallari, the latter being a paper for debate. Additional articles by a range of authors of diverse educational backgrounds and experiences are also published in this issue discussing the use of qualitative approaches to research and contributing for the theoretical reflection on these methodologies. The meeting report brings suggestions for the ethical analysis of qualitative health research proposals.
This special issue has no intention to contrast qualitative and quantitative methodologies, since both can be used in different paradigms, and complement each other in capturing the reality under investigation in a more comprehensive way. The key issue being discussed is the need for specific guidelines to analyze ethical aspects of research in different paradigms. The intention is to provide arguments for the improvement of ethical reviews for the benefit of human subjects, investigators and the population at large.
We thank the editors of Ciência & Saúde Coletiva for the possibility of collaborating with this discussion; all the authors for their invaluable contribution; Mirela Paula Pugas for the assistance in formatting the text. We hope that this special issue can help to deepen this debate.
Iara Coelho Zito Guerriero and Fabio Zicker