Unethical ethics? Reflections on intercultural research practices

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Unethical Ethics? Reflections on Intercultural Research PracticesAuthor(s): Silvia Salinas Mulder, Susanna Rance, Monica Serrate Suarez, Mery Castro CondoriSource: Reproductive Health Matters, Vol. 8, No. 15, Reproductive Rights, Human Rights andEthics, (May, 2000), pp. 104-112Published by: Reproductive Health MattersStable URL: http://www.jstor.org/stable/3775194Accessed: 24/06/2008 16:31

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Ulnlthca_ 3thcs? RefLections on

InteruilturaLi 3I eSaI iratics Silvia Salinas Mulder, Susanna Rance, Monica Serrate Suarez, Mery Castro Condori

The notion that there is a universal ethics is commonly supposed, but less often explicitly discussed, in protocols for ethical procedures in research. In this article, the authors reflect on their action-research with women farmers in a Bolivian highland province. Theirproject aims to propose ways in which local health services could better serve these women's expressed sexual and reproductive health needs. A series of field experiences led the authors to question the adequacy ofpre-established institutional protocols for informed consent. Cultural understandings in this context made for situations where supposedly ethical procedures led to unethical effects. While recognising the value of precautionary measures to avoid abuse of research subjects, the authors challenge the assumption of subjects' essential vulnerability in fieldwork relations. They found that they too, as researchers and outsiders to the community, could be assigned less than adult status by research subjects seeking empowerment in their own terms. The paper concludes that consent protocols, rather than relying on standardised procedures, should provide flexible alternatives to facilitate negotiation with subjects about whether and how they will participate at different stages of a research project.

Keywords: ethical research protocols, informed consent, intercultural research, research

methodology, ethnicity, Bolivia

[ HE action-research project referred to in this paper began with a request from the director of a Bolivian NGO1 that our pro- ject2 organise sexual and reproductive

health courses for Aymara women belonging to a milk-producers' organisation in a highland province. She drew our attention to frequent complaints by the women about damage to their health and lives from sexual violence, unwanted

pregnancies, unsafe abortions and lack of access to emergency care for gynaecological and obstetric emergencies. Data from a series of

exploratory interviews carried out by her - the

majority in Aymara - confirmed that there was indeed a gap between the women's expressed needs and the support offered by local health services.

We are currently engaged in research3 which explores these issues further through participant observation and analysis of the relations and encounters between Aymara women from five highland farming communities, and mestizo4 and

white-urban health workers in the province. We are generating proposals for the provision of services which take into account the rights and needs of women in these communities, particu- larly relating to sexual and reproductive health.

In the course of this project, we have con- fronted contradictions when attempting to apply pre-established, institutional ethical procedures developed from a multi-cultural or universal

perspective. In this article we explore diverse notions of principles such as 'personal auton-

omy' and the 'common good'.5 We offer concrete examples of the challenges involved in trying to 'ensure that research projects take into account local cultural and social attitudes'.6 We aim to show how ethical behaviour is diversely con- structed and negotiated through intercultural relations in a specific Bolivian setting.7

Intercultural relations permeate discussions within our research team as well as its field encounters with 'others'. As authors, we speak jointly about issues on which we have shared

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positions. However, in paying attention to the politics of representation, we also note our diverse identities and locations8 in the project: M6nica (white-urban psychologist) and Mery (rural Aymara anthropologist) as researchers, Silvia (white-urban anthropologist) as advisor and Susanna (gringa9 sociologist) as project coordinator. We alternate between collective and individual references in this paper to avoid homogeneity when this is not appropriate.

As yet, Bolivia has no national bioethics committee responsible for monitoring research interventions with human subjects.6 A sub- committee within the research committee of the National Forum for Sexual and Reproductive Health10 is developing guidelines on the ethics and politics of research. Some international agencies, such as the Population Council, which sponsors our project, have their own ethical review boards. The Council for International Organizations of Medical Sciences (CIOMS), affiliated to the World Health Organization, has drawn up a document of international ethical guidelines for biomedical research.5

On the basis of a shared commitment to gender equity and human rights, we recognise the importance of measures which many institutions have established to protect subjects from abuse in research. We have opted for the term 'subjects' to emphasise the selfhood and agency of people involved in our project, preferring this term to the more instrumental concept of 'informants' or the frequently idealised notion of'participants'.

Despite the value we put on institutional meas- ures to avoid harm, a series of critical incidents in the field have shaken our certainties and led us to reflect on the meaning of ethical procedures. We have come to the conclusion that overemphasis on subjects' vulnerability can distract attention from their overt and covert resistance to research interventions. Where power is constructed as a commodity in the hands of researchers, subjects may be implicitly demeaned as 'powerless' and as minors. An ethical strategy, while aiming to protect them, can paternalistically treat them in unethical ways.

As an example we mention our repeated insistence, in accordance with a pre-established ethical protocol, that these Aymara women should individually express voluntary decisions concerning their participation in the research project. The cultural differences within the

research team were reflected in our particular interpretations of informed consent and its relevance to a setting where the 'participation of everyone or of the majority is a value that prevails above all'.11

Mery was concerned about possible mis- understandings that the emphasis on informed consent might provoke among the Aymara women with whom she lives and works. She pointed out that our appeal to each woman to make an individual choice whether or not to participate in the project might be understood as indifference on our part, or even offence, since it could be taken to imply that we did not care whether all of them participated or not.

Mery also observed that drawing attention to potential risks for participants, as stipulated in the institutional ethics protocol,12 might be interpreted by them as 'calling evil'. In Aymara culture, the speaker who names possible ad- versity may be suspected of willing it to happen. Thus, in Mery's opinion, talking about potential risks would in itself have been a risky procedure. As Renzetti and Lee point out:13

'...the sensitivities and research risks that the investigator must recognise are not necessarily sensitivities and risks that the investigator con- siders to be real. The challenge, then, is to learn the perspective of those who will be the partici- pants and gatekeepers of the intended research and to design the research with those perspect- ives in mind.'

From the time Mery raised these problems, the cultural specificity of ethical principles became a central issue in our team discussions, evoking and accentuating concerns linked to former research experiences.

'We'll just sign a blank piece of paper' Early on in the project, the researchers organised a meeting with women in the milk-producers' organisation. They intended to ask those who attended to provide their written agreement to participate in the research and take an 'active' role in the process.

M6nica explained to them the goals of the research, how long it would last and what mechanisms were to be used for generating data. While she was speaking, she noticed that the

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women at the meeting seemed distracted and showed little interest in obtaining more informa- tion. Finally, she said that if they agreed to participate they would need to draft a letter expressing their consent. After waiting for questions and comments, which were not forth-

coming, she asked:14

'M6nica: Do you have any questions? Woman 1: No, we'll sign. Monica: You'll have to draft a letter. Woman 2: You just do it. Monica: But I have to put down what you want

to put. Woman 3: We'll just sign a blankpiece of paper.'

The intention had been to ascertain whether or not the women were willing to participate in the

project. We had hoped to draw up mutually acceptable terms and conditions with them, based on a negotiation of our respective inter- ests. Instead, the women were prepared to sign a blank sheet of paper. Paradoxically, rather than

limiting ourselves to seeking their signed in- formed consent, we had actually demanded their critical and active participation. What we effect-

ively received was their unconditional and un- limited consent. This response disconcerted us and made us question the ethical nature of the

consent-seeking exercise. The notion of informed consent is based on

the assumption that information is the key element influencing an individual's 'voluntary' decision. It does not always take into account the

multiple forms of inequity that permeate power relations and social dynamics.15 Informed con- sent cannot be reduced to the subject's individual will. Custom, tradition, social and cultural obliga- tions, prestige, access to material and symbolic resources, and past experiences can all power- fully affect personal and collective decisions.16

Why would this group of rural Aymara women agree to participate in an initiative such as ours, while showing no interest in critically discussing its terms? We find the principal explanation in Bolivia's long history of inter- national interventions. Research projects are

frequently associated with the possibility of grants for development activities. The anticipa- tion of material benefits can motivate partici- pation, despite explicit and repeated denial that such prospects exist.

Where inequities are expressed at all levels of society, applying 'universal' ethical norms can challenge subjects to make risky decisions - such as refusing to participate - that they may not wish to confront. 'Ethical' research can rarely avoid reinforcing existing relations of in-

equality,17 as other Latin American researchers have observed:

'For large financial agencies and universities in developed countries, informed consent means leaving open the possibility of refusing to partici- pate in a study, from the outset or while it is being implemented. However, in contexts like ours, where one of the main forms of oppression is individuals' lack of citizenship - that is to say, the almost total lack of knowledge by many of them, not only concerning their basic rights but also the very fact that they have rights - the presence of a researcher who 'offers' the right to voluntarily agree or refuse to participate tends to be viewed

by the actors concerned with a great measure of reserve and suspicion, since this gesture seems quite unnatural to them.'18

The bus incident: vulnerability and protection revisited A fundamental assumption of ethical protocols is that research subjects are essentially vulnerable and needy of protection from 'powerful' re- searchers. There is also an implicit idea that

subjects are themselves unable to identify re- searchers' intentions. This ethnocentric, one- sided approach does not contemplate the

possibility that subjects will use culturally specific strategies and codes to transmit dec- isions, express resistance and possibly set the researcher up as vulnerable.

We have come to recognise a dialectical relationship between assigning vulnerability and expressing resistance. In intercultural research relations, the interplay between these positions can lead each party to underestimate the 'other', thus achieving symbolic empowerment of its own

group. The construction of the 'other' as vulner- able can be simultaneously practised by re- searchers and subjects. In this way, the strategic distance between 'us' (the protectors) and 'them' (the protected) is reciprocally perpetuated.

In Bolivia, centuries of colonialist interven- tions have left deep-seated distrust among social

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groups divided by marked inequalities, discrim- ination and exclusion. This historical heritage 'colours' our experiences as researchers, and the manifestations of resistance that we encounter daily.

Monica and Silvia, as white, urban Bolivians, are often treated as foreign in rural research settings. One day, travelling on an inter- provincial bus, M6nica met four women from the milk-producers' organisation that had requested courses on family planning. During the journey they were talking about this topic when suddenly an unknown man intervened:19

'So these gringos,9 they come here to teach nonsense to the women. What do you want here with the women? There are gringas who come here to talk to the women. We don't know anything about that, we don't want anything from gringos.'

Vulnerability and protection are socio-cultural constructions, often based on a paternalistic underestimation of others' capacity to resist, and overestimation of one's own ability to take care and provide. The naming of 'vulnerable research subjects' serves to promote the self-empower- ment of those who set themselves up as protect- ors. Thus, protection and control become two sides of the same coin. We consider that ethics should be addressed as the outcome of power relations in which demands and interests are continually negotiated between researchers and subjects.

In the course of our fieldwork, we have seen resistance to our research agendas and methods crop up regularly. Its expression has varied from a direct refusal to be interviewed or to join an activity, to strategies such as silence and 'false' information. M6nica once noted when seeking an interview:20

'We arrived at R's house and asked for her. Her children told us she was not home. Some minutes later, when we were at a distance, we saw her leaving her house.'

A commitment to ethics might more effectively be demonstrated by exploring the interests we pursue in treating research subjects as partici- pants. Some of the people we seek to involve may indeed be keen to contribute actively to our

research. However, we cannot assume that this will always be the case and we should not label our subjects in advance in this way. Participation is a negotiated process that can wax and wane, be proffered and withdrawn. Constant checks are needed to ensure that the carte blanche apparently granted by an institutional credential or a signed consent form is not abused. Other- wise, we can push subjects past their limits, inducing them to resort to evasive tactics to resist an alien agenda.

The bicycle incident: Who protects whom? We have argued that standard ethical protocols construct research subjects as essentially vul- nerable. However, we believe that it is not enough to recognise subjects' capacity and will to resist externally established norms. From an intercultural perspective, researchers too can be subjected to constructions of vulnerability 'from the other side of the fence'.

Mery was struck when V, a 40-year-old woman from one of the rural communities in the study, challenged her about the way she treated M6nica:21

'Sister Mery, you've been going around so much by bicycle with that doctorita Monica.22 She even broke her wrist from biking around so much, didn't she. You're always running around from one place to another. I'd like to be in your shoes so I could get around like that. But the doctorita should take care, you shouldn't run around so much. She doesn't even know the place well, and some places have devils in them. I didn't know this myself, but Aunt G told me that the doctorita had fallen off the bike and broken her wrist. "She and sister Mery came and asked me to cure her," she told me. Otherwise I wouldn't have known. You must look after the poor little thing, she can't be used to going around so much by bike. In the city they don't ride bikes as much as they do here. You get around so much.'

This incident offers insights into the construction of the 'other's' vulnerability as a transcultural strategy to maintain distance between 'us' and 'them'. According to V, Mery as an 'insider' was not taking good care of Monica, whom she represented as a city girl whose scant rural

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knowledge and experience made her dependent upon Mery's protection. Trinh T Minh-ha notes that this kind of 'special care' is classically dispensed 'to the old, to the disabled, and to all those who do not match the stereotype of the real wo/man'.23

On that same day, P, another woman from the same community, also took Mery to task in Aymara about her 'handling' of M6nica, who was plastered with mud after a bike ride in the rain:21

'P: She must be your cousin, for you to handle that kid in such a muddy state. Mery: She's not my cousin, she's my workmate. We're working together with the women about health matters.

P keeps on complaining on M6nica's behalf. It's as though she hasn't understood a word of what we've explained to her.'

According to these women from the highland community, Mery had an obligation to protect Monica. In spite of her status in the project as principal researcher, M6nica was represented by both V and P as a vulnerable outsider and a

minor. Mery's fieldnotes continued to chart expressions of this demeaning strategy:21

'A man from LB community asks me: "Has your friend finished school?"

I reply: "She's finished school, and university too. She's a psychologist."

He answers: "I didn't realise she had finished university, Mery. Forgive me, you mustn't get angry about what I say to your friend. I didn't know anything about it. I asked you because it looks as if she's still in school, as if she's a minor".'

In Monica's case, being an outsider and having a youthful appearance were culturally constructed as signs of weakness and incapacity. 'Vulnerable' outsiders are represented as lacking resources for everyday life and survival, and requiring special care (and control). We interpreted these expressions of concern and attention as 'excluding privileges': while apparently benevolent, they were intended to keep her in a subordinate and marginal position. Throughout the project, we encountered this dynamic of mutual underestimation and overprotection. It had the effect of limiting the

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possibility of dialogue and interaction, with each party keeping the other firmly placed within a world of'otherness'.

Discussion: intercultural research and ethical relativism A clear-cut idea of good and evil is at the core of Christian ethics. However, this dichotomised world-view is not a universally shared approach to qualifying social behaviour. In Andean con- texts the limits between benevolence and harm, acceptance and rejection are flexible, relative and regularly crossed by individuals, depending on the situation. The required yes/no answer upon which informed consent is based is not coherent with Andean logic, in which an answer of 'may- be' leaves all possibilities open and symbolically builds a bridge between opposing forces and interests.24

In our attempts to apply institutionally defined protocols in intercultural settings, we have faced dilemmas that have challenged our preconceived notions about ethical research practices. We arrived at a notion of 'unethical ethics'25 when we realised that our would-be benevolent inter- ventions were often resisted by 'participants' as culturally inappropriate or potentially harmful.

Protective ethical measures are especially directed towards social groups who are subject to multiple forms of discrimination, such as rural indigenous women. Having obtained informed consent through using a formal protocol, researchers might be tempted to rest on their laurels. They might hold that their 'well-inten- tioned' interventions are ultimately beneficial for those studied (or for populations like them), and that they are carried out 'for their own good'26 even if this is not apparent at the time to the research subjects in question.

This circular argument serves to reproduce the very situations of inequity it purports to avoid. First, 'marginalised' populations are categorised as vulnerable. Secondly, they are subjected to research in the name of a 'higher good' such as scientific progress, refinement of medical skills or uncovering the workings of women's global oppression. Thirdly, the coup- ling of marginality with exposure to research is used to justify further 'protective' measures which can themselves be controlling and deeply manipulative. It is in this light that we have come

to criticise our early attempt to persuade the highland farming women to draft and sign their own statement of consent to join our study as willing participants.

If we recognise this moral trap, can we sustain any possibility at all of doing 'ethical' research with 'less advantaged' populations? As Daphne Patai says, 'Ultimately we have to make up our minds whether our research is worth doing or not, and then determine how to go about it in ways that let it best serve our stated goals.'27

If our stated goals include voluntary partici- pation of research subjects, it becomes apparent that this has to be negotiated and re-evaluated over a period of time with those involved. Despite our best efforts as researchers, the inequitable socio-cultural situations we set out to study will most probably be reproduced in our fieldwork relations.

Our intention in presenting these arguments is not to reject institutional protocols per se, but to stimulate further consideration of the com- plexity of the issues we have touched upon. Our experiences raise several questions linking ethical, cultural and political issues. Where are the boundaries between cultural relativism and ethical universalism, and who determines them? Beyond overt intentions to protect 'human sub- jects' from use and abuse, what other interests sustain institutional definitions of valid ethical practices? What are the political and material implications of ethical relativism in intercultural research? Is it possible to operationalise the notion of ethics as continuously negotiated in specific contexts and situations?

We suggest that research is most often motivated by the desire to obtain specific data, over and above any claim to work fairly or collaboratively with the communities being studied. This fact-seeking drive can conspire against the negotiation of diverse interests and agendas. It can also lead to 'take it or leave it' approaches to informed consent - 'Do you want to participate or not?' - rather than a more open 'How - if at all - would you be prepared to participate?'

Some researchers have demonstrated the possibility of developing specific ethical proto- cols based on agreements between all the parties involved. These can remain open to ongoing negotiation as the circumstances of a particular project develop. However, as Horwitz admits:28

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'Of course, given my social position and experi- ence as a fieldworker, I still have extraordinary control over the report, and the consent of the subjects in no way guarantees their empower- ment. But at least I do not begin by demanding a blank check. Both the informant and I have a story of what we might learn from each other, a version of its basis, and a veto power over the conclusion.'

If such a process is adopted from the start, it allows for flexible alternatives to the point-blank delivery or refusal of consent, as a once-and-for- all statement. We suggest that researchers devel- op an ethical checklist or set of qualitative indicators to be filled in, redefined and negoti- ated in each socio-cultural context.

For researchers, adopting a stance of ethical relativism can result in the sacrificing of some of the 'knowledge-seeking' goals of a project as originally conceived. Relinquishing some control in field relations can also lead researchers and institutions into the muddy terrains of vulnera- bility and risks of their own, which in more paternalistic models are assumed to be inhabited only by those studied.

In multi-ethnic countries, such as Bolivia, and also in feminist research, the issues we have discussed may be considered especially relevant to protecting the rights of indigenous women. However, we join Mohanty29 and Parpart30 in criticising certain academic representations of a homogeneous 'Third World woman', who is poor, powerless and vulnerable, and her West- ern opposite, who is educated, liberated and the epitome of modern femininity. The link between intercultural relations and ethics is not only 'special' to Third World women.23 In confronting these stereotypes, all researchers can benefit from reflecting on their own ethnic and cultural self-location. Diversity, equity and human rights are concerns affecting researchers, research subjects/participants and institutions in all societies.

Our intention is to stimulate further exchanges between those involved in research, with a view to enriching existing ethical proto- cols. The challenge, as we see it, is to maintain the safeguarding spirit of informed consent guide- lines, without falling into an ethnocentric and paternalistic construction of subjects as vulner- able minors.

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Acknowledgements Our reflections have been stimulated by discuss- ions with members of the Ethics and Politics Sub- committee of the Committee for Research, Evaluation and Population and Development Policy (CIEPP), which forms part of Bolivia's National Forum for Sexual and Reproductive Health. The Population Council sponsors the

research project to which we refer in this paper. Thanks to Barbara Bradby for comments on an earlier draft of part of this paper.

Correspondence Silvia Salinas, PO Box 202, La Paz, Bolivia. E-mail: ssalinas@ceibo. entelnet.bo

References and Notes

1. Albertina Castro Caceres, then director of the institution JATH'A.

2. Andean strategy to reduce the

impact of unsafe abortion on women's health and wellbeing', Population Council, Bolivia, 1998-2000.

3. The project 'Action-research on sexual and reproductive health with women in rural areas' (1999-2000) is a component of the 'Andean strategy'.

4. Mestizo, a term used in Iberian and Latin American contexts to indicate mixed race, ethnicity or culture (in this setting, Aymara/Hispanic).

5. CIOMS/OMS, 1993. Pautas Eticas Internacionales para la Investigacion y Experimentaci6n Biom6dica en Seres Humanos. ppll-12. Geneva: CIOMS/OMS.

6. Layton R, 1993. The work of national bioethics committees in Australia: a history. Reproductive Health Matters. 1(2):94-97.

7. 'Intercultural' is defined as 'taking place or forming a communication between cultures, belonging to or derived from different cultures' (OED). This concept'refers above all to the attitudes and relations of individuals or human groups of one culture with reference to another cultural group, its members or features and cultural products'. In: Alb6 X, 1999. Iguales aunque Diferentes. La Paz: Ministry of Education/UNICEF/CIPCA. p84. (our translation)

8. Lal J, 1996. Situating locations:

the politics of self, identity and 'other' in living and writing the text. In: DL Wolf (ed). Feminist Dilemmas in Fieldwork. Boulder CO: Westview Press, pp185-86.

9. Gringa (f) or gringo (m) is a term of uncertain origin which in some Latin American countries, including Bolivia, is used to refer to white Northerners, often assumed to be from the USA. It can bear connotations varying from ironic humour

through distancing otherness to

anti-imperialist contempt. 10. The National Forum for Sexual

and Reproductive Health, founded in 1999, is a Ministry of Health-led umbrella organisation coordinating all State, non-governmental and international initiatives in the field of sexual and reproductive health.

11. Alb6 X et al, op. cit. p149. (our translation)

12. 'The Informed Consent Form must include information

regarding the following: (...) - Risks to the subject, including physical, social and emotional. (...) Discomforts and risks: describe any attendant discomforts and risks to be expected.' Population Council Ethical Review procedures pp 4, 11.

13. Renzetti CM, Lee RM, 1993. Researching Sensitive Topics. Newbury Park CA: Sage Publications. p18.

14. Fieldnotes, M6nica Serrate, 15 July 1999.

15. Fluehr-Lobban C, 1994. Informed consent in

anthropological research: we are not exempt. Human Organization. 53(1):1-10.

16. Brewster-Smith M, 1976. Intellectual, legal, and philosophical issues regarding use of social resources and human participants in social science research. Presented at Symposium: Ethical Issues in Social Science Research, University of Minnesota.

17. Patai D, 1991. US academics and Third World Women: is ethical research possible? In: SB Gluck, D Patai (eds). Women's Words. The Feminist Practice of Oral History. New York: Routledge.

18. Castro R, Bronfman MN, 1997. Algunos problemas no resueltos en la integraci6n de m6todos cualitativos y cuantitativos en la investigaci6n social en salud. Cocoy6c, Mexico: IV Congreso Latinoamericano de Ciencias Sociales y Medicina.

19. Fieldnotes, M6nica Serrate, 15 May 1999.

20. Fieldnotes, M6nica Serrate, 12 December 1999.

21. Fieldnotes, Mery Castro, 14 January 2000.

22. 'Doctorita', diminutive form (affectionate, infantilising or demeaning) of'doctora', a female doctor.

23. Minh-ha TT 1987. Difference: 'A special Third World women issue'. Feminist Review. 25:5-22.

24. Alb6 X, op cit. pp139-40. 25. Silvia Salinas proposed this

concept in a personal communication with Susanna Rance, July 1999: 'An act that is itself based on ethical principles

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can end up being almost "unethical".'

26. Ehrenreich B, English D, 1978. For Her Own Good. 150 Years of the Experts'Advice to Women. New York: Doubleday.

27. Patai D, op cit. p150. 28. Horwitz R, 1993. Just stories of

ethnographic authority. In: C Brettell (ed). When They Read What We Write: The Politics of Ethnography. Westport: Bergin and Garvey. pp137-38.

29. Mohanty C, 1988. Under Western eyes: feminist scholarship and colonial

discourses. Feminist Review. 30:61-88.

30. Parpart JL, 1994. Who is the 'other'? A postmodern feminist critique of the theory and practice of women and development. Development and Change. 4(3):439-64.

Resume Les protocoles des procedures 6thiques des travaux de recherche acceptent g6n6ralement l'existence d'une 6thique universelle, mais il est plus rare qu'ils l'abordent de maniere explicite. Dans cet article, les auteurs r6flchissent a leur recherche avec des agricultrices dans une prov- ince montagneuse de Bolivie. Leur projet vise a

sugg6rer comment les services locaux de sante pourraient mieux desservir les besoins exprim6s de ces femmes en sant6 g6n6sique. Une s6rie

d'exp6riences pratiques ont conduit les auteurs a remettre en question l'ad6quation des protocoles institutionnels pre-etablis pour le consentement eclaire. Des compr6hensions culturelles dans ce contexte ont contribu6e des situations ou des proc6dures suppos6es 6thiques ont abouti a des effets non 6thiques. Tout en reconnaissant la valeur des mesures de precaution pour 6viter d'abuser des sujets de recherche, les auteurs s'interrogent sur la suppos6e vuln6rabilit6 des

sujets dans les relations sur le terrain. Ils observent que eux aussi, en tant que chercheurs et 6trangers a la communaut6, peuvent se voir attribuer un statut inferieur a celui d'adulte par les sujets de la recherche qui tentent de prendre le dessus a leurs propres conditions. L'article conclut que les protocoles de consentement, plutot que de se fier aux procedures normalis6es, devraient fournir des options souples pour faciliter la n6gociation avec les sujets afin de savoir s'ils accepteront de participer et de quelle maniere aux differentes 6tapes d'un projet de recherche.

Resumen La idea de que exista una etica universal es un supuesto comuin, pero poco explicito, en los protocolos de 6tica aplicados a las practicas de investigaci6n. En este articulo, las autoras reflexionan acerca de sus investigaciones con campesinas en una provincia del altiplano boliviano. El proyecto pretende ofrecer propuestas para mejorar la atenci6n prestada por los servicios de salud locales con el fin de satisfacer las necesidades en materia de salud reproductiva y sexual expresadas por estas mujeres. Una serie de experiencias en el terreno llevaron a las autoras a cuestionar lo apropiado de los protocolos institucionales preestablecidos para obtener el consentimiento informado. La

comprensi6n cultural en este contexto cre6 situaciones en que las practicas supuestamente 6ticas produjeron efectos poco 6ticos. Si bien reconocen el valor de las medidas de precauci6n que pretenden evitar el abuso de los sujetos de

investigaci6n, las autoras cuestionan la supuesta vulnerabilidad esencial de los sujetos en las relaciones de trabajo sobre el terreno. Las autoras descubrieron que a ellas, como investigadoras y forasteras en la comunidad, tambi6n se les podrian asignar un status correspondiente a menores de edad, de parte de los sujetos de la investigaci6n que buscaban empoderarse en sus propios terminos. Como conclusi6n, los protocolos de consentimiento, deben facilitar la negociaci6n con los sujetos sobre su participaci6n en las distintas fases de un proyecto de investigaci6n, asi como los t6rminos de su participaci6n.

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