PSY 650 Module 7 Research Ethics Example

From Tuskegee to a Small Practice: Lessons of Research Ethics for Using Client Records

Student Name

Psychology and Addiction Studies Program, Aspen University

PSY 650: Ethics

Instructor Name

Month Day, Year

From Tuskegee to a Small Practice: Lessons of Research Ethics for Using Client Records

For five years, Hannah's group practice in Montana, invented for this course, has asked clients to complete a brief symptom questionnaire every few sessions. Clients consent to this at intake as part of their care, and the scores help counselors track progress. Greg, Hannah's colleague, has proposed analyzing five years of scores to show how clients improve and publishing the results in a professional journal. This paper considers what research ethics require.

A Lesson From Mainstream Journals

Beecher (1966), a professor of anesthesia, published an article describing examples of unethical studies drawn from leading medical journals and institutions. Some withheld known effective treatment; others exposed participants to risks without telling them; many lacked any evidence of consent. His point was that ethical failures were not confined to a few rogue scientists but appeared in respected work by respected researchers who believed their aims justified their methods. He argued that informed consent and, above all, the conscience and integrity of the investigator were the main safeguards.

A Lesson From Tuskegee

Brandt (1978) traced the history of the federal government's observation of untreated syphilis among Black men in Macon County, Alabama, which lasted four decades from its start in the early 1930s. Hundreds of men who had syphilis were watched rather than treated and were deceived about what was being done to them; they were told they were being treated for "bad blood." Even after penicillin became the standard cure in the 1940s, the study continued and the men were kept from treatment. Brandt argued that the study rested on racist assumptions about Black people and disease and that those assumptions allowed physicians to see the men as subjects for observation rather than patients owed care. The study ended only after a public health worker's concerns reached the press.

Modern Requirements

Emanuel et al. (2000) proposed seven conditions that ethical clinical research must satisfy. A study has to be worth doing and sound enough to answer its question. The people in it should be chosen because the question requires them, not because they are convenient or easy to pressure. Expected benefits must outweigh the risks. Someone without a stake in the study must review it. People must agree to take part knowing what it involves. And once enrolled, they keep their claims to privacy, to leaving and to hearing what was found. They argued the requirements are universal but must be applied with sensitivity to context.

Evaluation or Research?

The practice's existing use of scores is program evaluation. Greg's proposal, analyzing records to produce generalizable findings for publication, is research, and the clients consented only to the first.

Applying the Requirements

Value and validity: the study could show how clients in a rural practice improve, a question with little published evidence, but only if the analysis accounts for clients who left early and does not overstate results. Fair selection: all clients with scores would be included, not only those who did well. Risks and benefits: the main risk is to privacy; the benefit is to knowledge and potentially to other rural clients. Independent review: the practice has no review board of its own and would need to seek review from an external board, such as one at a nearby university or an independent commercial board. Consent: past clients did not consent to research use; the board might allow use of de-identified records without individual consent if risks are minimal, but current clients could be offered the chance to opt out. Respect: findings would be shared with clients in a newsletter.

Lessons Carried Forward

Neither Beecher's examples nor Tuskegee involved a small counseling practice, but both carry lessons for one. Beecher showed that researchers who are confident in their aims tend to underweight the people bearing the risks, which is why the practice should not judge its own proposal. Tuskegee showed that people seen as less entitled to full information can be harmed by those charged with their care. Rural clients, clients with low incomes and clients who have little choice of counselor deserve the same consideration as any research participant, and arguably more care, because they cannot easily go elsewhere if they object.

Privacy in a Small Town

De-identification is harder in a town of eight thousand. A published table showing that "a man in his fifties with a back injury" improved could identify a client to readers who know him. The practice decided to report only aggregate results, to suppress any group smaller than ten and to omit occupations, exact ages and rare circumstances.

Who Benefits

Research ethics asks who bears the risks and who gains. Here the clients bear a privacy risk, small if the protections hold. The practice gains reputation, and its counselors gain a publication. The wider field and future rural clients may gain knowledge. Because the practice gains directly, the risk of self-serving judgment is real, another reason the decision about whether the study may proceed belongs to an independent board rather than to the practice itself.

The Decision

The practice agreed to seek external review before any analysis, to use only de-identified data, to give current clients a clear chance to opt out and to report results in aggregate with small groups suppressed. Hannah noted that the history of research ethics, from Beecher's respected researchers to the physicians of Tuskegee, shows that good intentions are not enough; independent review exists because researchers are poor judges of their own projects.

Conclusion

Beecher showed that unethical research appeared in mainstream journals, and Brandt showed how racism enabled decades of deception and harm at Tuskegee. Emanuel, Wendler and Grady's seven requirements turn those lessons into standards. Applied to a small practice's plan to publish client outcomes, the requirements called for independent review, de-identification suited to a small community and respect for clients' choices.

References

Beecher, H. K. (1966). Ethics and clinical research. New England Journal of Medicine, 274(24), 1354-1360. https://doi.org/10.1056/NEJM196606162742405

Brandt, A. M. (1978). Racism and research: The case of the Tuskegee Syphilis Study. Hastings Center Report, 8(6), 21-29. https://doi.org/10.2307/3561468

Emanuel, E. J., Wendler, D., & Grady, C. (2000). What makes clinical research ethical? JAMA, 283(20), 2701-2711. https://doi.org/10.1001/jama.283.20.2701