Grief Without Consent Grief Counseling:

¶ … Grief without Consent

Grief counseling: Ethics

At the most basic level, a blatant misrepresentation has occurred regarding the patient-physician relationship. The patients had no reason to suspect that the researcher gathering data on them was anything other than healthcare practitioner. They gave the raw material to him for his study without their consent. Their thoughts and feelings were obtained under a pretense. Even the most basic ethics of the 'golden rule' to 'do unto others as you would have done unto yourself' are 'undone' in this example. A complete deception was practiced, and citizens were rendered test subjects against their will. This violates the implied social relationship that exists between physician and patient that the physician will do all he or she can to heal the patient, without ulterior motives of gathering research, unless this motivation is expressed to the individual, as in the case of a drug trial. While the researcher's utilitarian ethics might uphold the idea that the 'greatest good for the greatest number' is served by conducting a study, in actuality by undermining public confidence in confidentiality, less 'good' is served for the world as a whole by the use of such unscrupulous practices.

Of course, in some studies, scientists will construct ethically acceptable falsehoods. For example, when studying if a certain high-carbohydrate supplement is effective for cyclists, the scientists might divide the volunteers into two parties, a control and an experimental group, but want to mitigate the fact that a placebo effect might occur for the cyclists that know that high-carbohydrate supplements increase athletic performance. So they may tell both groups that they have definitely taken a high-carbohydrate supplement, even though only one group has done so to 'even out' the possible psychological placebo effect. Since all subjects agreed to take part in the study and possibly take a supplement, this is an ethically acceptable deception according to most guidelines. A utilitarian calculation might suggest that the greatest good for the greatest number was achieved -- the scientists were able to pursue satisfactorily ethical scrupulosity without harming the patient's trust, as the patients knew they were 'subjects.' This was not the case with the study regarding the bereaved patients. Of course, some might argue that the subject of study was merely grief, and not something that cast potentially negative aspersions on the subjects. But the subjects might feel embarrassment at revealing grief, and it is not right to force them to reveal themselves for a utilitarian greater good of a study.

It is important to point out that quite often ethical guidelines in medical research are ambiguous: for example, even a person who does not want to be examined by medical students may find him or herself in a teaching hospital, being observed by residents and given little choice but to consent to being observed. Researchers have conducted similarly dubious ethical experiments that may show their subjects in an unflattering light, such as one in which seminarians at Yale Divinity School were asked to deliver a 3-5-minute talk, one group on an unrelated topic, the other group on the parable of the Good Samaritan. A confidant posing as a bystander was asked to look ill and the concealed experimenters took note of when the students stopped to help the ill man, as they were hurrying to give their talk. But "when subjects appeared for the experiment they were told that they were participating in a study of the vocational careers of seminary students" not that their morality was the real intent of the study (Garret 2006). Had they been informed of the real subject of the experiment, the seminary students may have behaved differently. Ethical misinformation was part of the construct -- their moral reactions, just as in the grief study, were being observed.

However, the relationship between doctor and patient is a particularly sacred one, given that patients must feel free to confide in their doctors. The emotionally vulnerable state of the subjects calls for special care on the part of researchers. While one could argue that the greatest good for the greatest number was being conducted by doing the study, the harm this could do to the patient-doctor relationship would be so detrimental to society no possible information revealed by the study could defend the deception that was practiced. For example, after the study is revealed it is possible a patient might read the research and feel shocked by the researcher's lack of ethics. That person might not reveal his or her grief to a doctor after the death of a loved one, and fall into a deep and untreated depression -- or worse. Unless a person poses a danger to himself or others, confidentiality can and must be respected, so doctors can ascertain a complete picture of a patient's medical history.

Professional ethics differ from profession to profession -- the ethics of an undercover reporter are different from those of a doctor or a therapist. While the personal life of a politician is debatably fair game for a journalist, it is not ethically valid for a researcher to publish personal information without the individual's consent, or his or her family's consent. (Other examples of different ethical contexts include a lawyer who is not ethically bound to present both sides of a story equally to a jury, versus a journalist who is writing a feature piece -- not an editorial -- on a controversial subject).