What is the right way to treat people? When Maria Merritt, an assistant professor inInternational Health and core faculty at the Johns Hopkins Berman Institute of Bioethics, digs into data from her studies, that question guides her.

 

More specifically, she asks of the data, What is the right way to treat the people who participate in community-based public health field trials in low-income settings?

 

“There’s little, if any, established guidance,” says Merritt, PhD. “If investigators want to do the right thing, they have to figure it out on their own.”

 

Most of the bioethics work so far applies to the researcher-participant relationship in relatively well-funded clinical settings. Bioethicists provide plenty of guidance on issues such as informed consent and genetic testing. But in a field trial in Bangladesh, for example, the ethical questions that arise look different.

 

One such question is that of parallel treating. If study workers in a maternal health field trial encounter participants who suffer from injury or malnutrition, should they treat the participants for their co-morbidities? Parallel treatment, or ancillary care, stirs up further quandaries: How much is enough? Could the treatment jeopardize the study? The questions go beyond ancillary care, as well. Study teams sometimes have opportunities to provide benefits for the community at large—chlorinating a well, for example—and have to make decisions about how much to do.

 

To answer these questions, Merritt and her colleagues Holly Taylor, also a core faculty member at the Berman Institute, and Luke Mullany, assistant professor in International Health, have a project under way...