Results

This chapter assesses the ethical issues raised by this inquiry, from inception, design, undertaking through to dissemination. A reflexive inquiry does not require ethical approval either from Bournemouth University nor the Society of Homeopaths Ethics Committee. Bournemouth University Research Ethics Code of Practice (September 2009) provides the ethical framework. To ensure that ethical issues were addressed throughout the research, they were discussed at regular intervals in supervision and monitored annually by the School’s Research Committee. Membership of the SoH Research Committee provided a forum for discussing ethical issues situated in the profession. To use STAR data in my doctoral inquiry, I submitted to the Dean of the School of Integrated Health (December 2005) a ‘Statement of Class 1 Ethical Approval’ (see Appendix 1), demonstrating how my research activities with STAR complied with ‘University of Westminster Code of Practice governing the ethical conduct of investigations, demonstrations, research and experiments’ (2004). Arrangements for one-to-one interviews and focus groups were included in the University of Westminster Class 1 ethics statement. These were not conducted as sufficient data were generated through STAR and reflection on my own professional practice. Let us now consider key ethical principles. These are conceptualised not as abstract principles but situated within the context and trajectory of the inquiry.

8.2.1 Use of researcher as participant

I negotiate a fine line between transparency and honesty, and considerations of self-exposure for both myself and other professional homeopaths. As a reflexive inquiry, the use of self in research raises many dilemmas. How much do I disclose to be able to illuminate my work without risking a sense of inappropriate self-exposure? This is an iterative theme in my reflective writing to reach some sense of equipoise. I operate self-surveillance as I police what I imagine other homeopaths may find potentially damaging to their professional identities. I am emboldened by reflecting on John’s statement:

“The risk of compromise to make narratives acceptable is to sanitise them and risk their potency.” (Johns, 2000, p.61)

8.2.2 The visibility of others in the text Continuing to draw on Johns’ insights:

“Self is always viewed in relationship with others....others become visible within the narrative, and because the narrative is subjective and contextualised, the other is more easily recognised.” (2000, p.58)

Other homeopaths contribute to this inquiry as I reflect on my participation in professional activities, such as continuing professional development and conferences. I use my own reflective narratives and impressions of the discussion as data. I acknowledge that there is a fine line between my impressions of a discussion, as distinct from what others said or did. As

homeopaths are a relatively small profession, I have been vigilant to avoid any details that could identify individuals.

Another important group of inquiry participants are the people who consult me for homeopathic treatment. A number of long term patients have taken quite an interest in the my doctoral studies, and have volunteered to contribute and asked to read the completed thesis. Whilst maintaining patient confidentiality, patient’s comments and accounts are vital to this inquiry. Reflection on practice attends to practitioner experience and not patients or their clinical cases. As the practitioner experience involves working with others, it is not possible to separate off the homeopath. To avoid using patient’s narratives or their clinical information, I have given attention to the clinical process rather than the patient. I employ the clinical report genre to present constructed narratives which synthesise multiple clinical experiences and fictionalised personal stories.

8.2.3 Am I providing ammunition for critics of homeopathy?

This is a reference to a homeopath’s comment. After reading an early draft, she was particularly concerned that I was presenting homeopathy as ‘unscientific’ and drawing attention to the lack of reproducibility in prescribing regimes between homeopaths. All texts are open to multiple readings, and by inviting readers to participate in this text, the field of interpretation is wide open. The political context for homeopaths has changed during the course of the inquiry, with high profile scepticism in the popular media. This has changed potential readings of the text. The inquiry will be judged by its credibility. I am in dialogue with my ‘internal supervisor’ (Casement, 1990) about how to explore my doubts, uncertainties and the contradictions of practice. I attend to multiple truths, whilst also being cautious not to bring the profession into disrepute.

8.2.4 Deception

Constructed clinical reports respect patient confidentiality and fictional dialogues obscure individual contributions from patients and colleagues. As fictional narratives, do they falsify patient reported responses following homeopathic treatment? Am I misrepresenting the view points of others? How do I present an authentic self with integrity to my own practice? Answers to these questions rely on your view point. If you read this thesis from a realist deterministic standpoint, you may consider these accounts to be of minimal research value. Truthfulness relies on assumptions about the nature of another person’s sense of realities. This inquiry is offered within a postmodern framework that is open to multiple and competing view points and rejects the certainty of describing a single truth. The constructed accounts are not truth claims but attempts at exploring, reappraising and analysing experience. These attempts offer different facets of my professional experience and I ask you to configure these to make our own interpretations.

8.2.5 Informed consent of participants

Consent is socially constructed as conferring trust on the researcher to have the participants’ best interests at heart and not to cause any harm. As STAR was a staff development activity for a team of clinic tutors, we did not require ethical approval. We developed, agreed and renegotiated our ground rules for group work. At the end of the project I submitted a ‘Statement of Class 1 Ethical Approval’. I emailed each participant an information sheet and a request for permission to reanalyse the STAR data they had contributed (transcripts of discussion, action learning sheets and reflective papers) as a source of professional experiential data in my doctoral inquiry. The consent form also asked each individual to indicate if they would be willing to be approached for permission to quote specific extracts from their contributions (see Appendix 1). As this request was retrospective, participants already had agreed copies of transcripts and could make an informed decision about withdrawing all or any of their contributions.

8.2.6 Coercion for colleagues to act as participants

This principle is particularly pertinent to STAR. At the proposal stage I verbally explained my personal motivations to all participants individually. When exploring action research in an earlier chapter (Analytical Strategies chapter 6) we questioned whether action research can be truly participatory and egalitarian because of the perceived authority of the researcher. STAR was a potential site for the exercise of power of the facilitator/researcher and loss of autonomy of co- participants. This power dynamic was heighted as I was in a more senior academic position to most of my colleagues, with some line management responsibilities. Dependency on the researcher to preserve a ‘good working relationship’ can persuade colleagues to participate (Butler, 2003). There is potential for role conflict and confusion. The working relationship shapes the data produced and ‘openness and truth-telling could be compromised’ (Butler, 2003, p.21). Keeping a reflective journal on my facilitator experiences and regular supervision with a colleague, who was experienced as a facilitator, was essential to help me manage group dynamics and group processes in the most effective ways. Colleagues said that they wanted a more proactive facilitator at times and I resisted this. There is a definite risk that participants felt duty bound to be involved in STAR and to offer me access to the data. I sought to manage the risk by emphasising, both verbally and in documentation, that they were free to decline or to withdraw. They all participated throughout STAR and offered me access to their data, indicating perhaps that they felt duty bound to do so.

8.2.7 Protection of participants from discomfort, harm or risk

All contributions from others used in this thesis are anonymous and any identifying details have been removed. Arguably the data is not sensitive as it primarily concerns constructions of clinical knowledge, rather than specific points of view or personal experiences. However, the ‘Information sheet for STAR participants’ draws attention to the difficulties of ensuring anonymity as within the relatively small professional community, individuals are easily recognisable. In the Ethics Statement I outlined strategies to manage this as far as possible.

8.2.8 Degree to which risks are balanced against potential benefits

With integrity and thoroughness, my intention is to increase understanding of the practice of homeopathy. Undertaking this inquiry has had a profound effect on the way I view and conduct my clinical work and professional activities. Whilst the time commitment has impinged on my availability to patients, undoubtedly the experience of researching my own practice has benefitted the quality of care I provide.

8.2.9 Debriefing of participants and peer review

STAR provided an arena for knowledge transfer as I disseminated learning from my doctoral studies through participation in peer supervision. For example I contributed a model of action learning, different supervisory models and theoretical perspectives on reflection-in-action, and also contributed my evolving perspectives on professional knowledge in homeopathy. All STAR participants were invited to attend and contribute to a presentation to the funding panel and I presented a paper on my doctoral inquiry in the School of Integrated Health (March 2009). As I am drawing on my professional experiences, peer review is indispensable and I am committed to contributing to the development of research in CAM. For details of papers presented see 7.6.4).

8.2.10 Confidentiality

All identifying information has been removed from STAR transcripts excerpts and reflections on discussions/encounters with others. All data provided by STAR participants has been stored confidentially in a locked personal filing cabinet and computer data is password protected. Data collected is not subject to the Data Protection Act 1998 as it does not affect participants’ privacy in their personal lives nor in their professional capacities.

8.2.11 Copyright

Permissions gained for use of copyright images (see appendix 2).