Chapter 4.3: People in dependent or unequal relationships. National Statement on Ethical Conduct in Human Research (2007) - Updated 2018

Introduction – Chapter 4.3

This chapter is about pre-existing relationships between participants and researchers or between participants and others involved in facilitating or implementing the research. These relationships may compromise the voluntary character of participants' decisions, as they typically involve unequal status, where one party has or has had a position of influence or authority over the other. Examples may include relationships between:

• carers and people with chronic conditions or disabilities, including long-term hospital patients, involuntary patients, or people in residential care or supported accommodation
• health care professionals and their patients or clients
• teachers and their students
• prison authorities and prisoners
• governmental authorities and refugees
• employers or supervisors and their employees (including members of the Police and Defence Forces)
• service-providers (government or private) and especially vulnerable communities to whom the service is provided.

Those mentioned first in each of these examples will sometimes be involved as researchers, as well as being involved in facilitating or implementing the research.

Values, principles and themes that must inform the design, ethical review and conduct of all human research are set out in Sections 1 and 2 of this National Statement. The guidelines and headings below show how those values, principles and themes apply specifically in research that is the subject of this chapter.

Guidelines – Chapter 4.3

Research merit and integrity

4.3.1 Being in a dependent or unequal relationship may influence a person's decision to participate in research. While this influence does not necessarily invalidate the decision, it always constitutes a reason to pay particular attention to the process through which consent is negotiated.

4.3.2 In the consent process, researchers should wherever possible invite potential participants to discuss their participation with someone who is able to support them in making their decision. Where potential participants are especially vulnerable or powerless, consideration should be given to the appointment of a participant advocate.

4.3.3 In the research design, researchers should identify and take steps to minimise potentially detrimental effects of:

1. (a) an unequal or dependent relationship on the conduct of the research
2. (b) the research on participants involved in the relationship.

Justice

4.3.4 People in the categories of relationship described in the Introduction to this chapter are vulnerable to being overresearched because of the relative ease of access to them as research populations. Researchers should take account of this vulnerability in deciding whether to seek out members of these populations as research participants.

4.3.5 Where participants are in a relationship of dependency with researchers, researchers must take particular care throughout the research to minimise the impact of that dependency.

Beneficence

4.3.6 Researchers need to be mindful that in some relationships of dependency, participants may have an unrealistic expectation of the benefits of research.

4.3.7 A person declining to participate in, or deciding to withdraw from, research should not suffer any negative consequences, such as unfair discrimination, reduction in the level of care, dismissal from employment, or any other disadvantage (see paragraphs 2.2.19 and 2.2.20).

Respect

4.3.8 The design of research involving those in dependent relationships should not compromise respect for them.

4.3.9 Where the researcher has a pre-existing relationship with potential participants, it may be appropriate for their consent to be sought by an independent person.

4.3.10 Researchers should take special care to safeguard confidentiality of all information they receive, particularly in settings such as shared workplaces, hospital rooms or rooms in residential care.

Authors of this National Statement

This National Statement has been jointly developed by the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC) and Universities Australia (UA). This joint undertaking reflects a widely shared conviction that there is a need for ethical guidelines that are genuinely applicable to all human research and it gives expression to the shared responsibility for ethically good research described above.