In research, the principle of beneficence—in concert with the principle of non- maleficence—demands that the benefits of a study outweigh the risks to an individual or wider society (Holloway & Galvin, 2016). Beneficent actions are understood in a dual sense, whereby the researcher must avoid harm altogether or, if risks are involved for achieving significant benefits, minimise the harm as much as possible (Christians, 2013). In other words, researchers must establish a favourable risk-benefit ratio. In minimising risks and enhancing the potential benefits of their work, researchers must be sensitive to the welfare and interests of those involved in their research, while considering any social and cultural implications of their work. Concerning the current study, older adults and those with a mental illness rate depression as a priority research topic and are highly motivated to participate in research (Banfield, Barney, Griffiths, & Christensen, 2014; National Ageing Research Institute, 2013). Thus, the benefits to society are an important result of research, but they should be achieved through just means, be distributed fairly, and present no unjust burdens (National Health and Medical Research Council, 2018b).
The significance and contribution of the current study have been outlined elsewhere.84 In this study, harm pertains to the way in which the researcher assessed and took account of the risks of harm or discomfort to participants. Whereas there was no physical risk of harm to participants, participating in a qualitative interview may provoke distressing memories (Alexander, 2010; Holloway & Wheeler, 2010). Given the focus of the study, there was a foreseeable risk of participants experiencing distress as they recounted their experiences around diagnosis, treatment and management of depression. A protocol was in place to guide the researcher’s response if this occurred. Initially, the researcher would offer initial emotional support and offer to pause the interview. If the participant preferred not to proceed, the interview would be terminated. A psychologist based at the university had been briefed on the study and was available to provide formal support, at no cost to participants.85 This service was not requested by any participant. Although several became mildly distressed during their interviews, they remained articulate and expressed the desire to continue with the interview. This behaviour is consistent with evidence that
84 See 1.4 (Justification for the study).
interview participants generally find it helpful to share their experiences and insights on a personal level, even when they may experience a level of discomfort or distress (Wolgemuth et al., 2015). This was evidenced on one occasion, when a participant became angry and tearful as he recalled the circumstances around his sudden retrenchment, which resulted in early retirement. When the researcher offered to pause the interview, Nick (a pseudonym) clearly expressed his wish to continue with the interview. By the time the interview concluded, Nick was showing no signs of distress and thanked the researcher for the opportunity to share his experiences and strategies for managing his depression.
Non-maleficence and vulnerable participants
The principle of beneficence stipulates that research should produce recognisable benefit to participants and the wider community. Non-maleficence requires us not to do things that may be harmful to others (Sim, 2010). This principle prohibits researchers from causing or allowing psychological or physical harm to research participants, including indignity, deception or being used as an object (Pollock, 2012).
Depending on the research, setting and participant characteristics, the risks and potential harms of qualitative research are often considered to be lower than in some intervention studies (Pollock, 2012). However, the imperative to balance the pursuit of knowledge with ethical responsibilities is especially important for researchers working with vulnerable populations (Bay-Cheng, 2009). Although there is a lack of consensus on what it means to be vulnerable, the term typically applies to children, older adults, those with mental disorders or learning difficulties, those who lack the mental capacity to give consent and those in a dependent or unequal relationship (Alexander, 2010; Bay-Cheng, 2009). Patients receiving palliative care are also vulnerable (Alexander, 2010). The sensitivity of the topic of research should also be taken into account.86 Qualitative research that explores sensitive topics in depth may involve emotional and other risks to participant and researcher (Wolgemuth et al., 2015). However, the process of participating in research can be empowering and cathartic for participants, with several
86 In research, a sensitive topic is one which poses a potential risk to those involved, which may make the collection, holding or dissemination of data problematic for participants and/or researchers (Decker, Naugle, Carter-Visscher, Bell, & Seifert, 2011). Examples include childhood sexual abuse, domestic violence, trauma or grief (Decker et al., 2011; Wolgemuth et al., 2015).
studies reporting the likely benefits to participants across a wide range of sensitive study topics, participant samples and methodologies (Decker et al., 2011; Warburton, Bartlett, Carroll, & Kendig, 2009; Wolgemuth et al., 2015).
Although no risks of physical harm were identified in the current study, there was a low risk that participants may become mildly distressed when sharing their experiences of ageing and depression. The risk of psychological harm to participants can be minimised by the researcher following the principles of respect for human dignity and justice. Clear protocols, approved by the Human Research Ethics Committee, were in place to respond to any distress that might be experienced by participants. In the event, none elected to contact the researcher or her supervisors to seek emotional support. This was confirmed with the psychologist who had made himself available for this purpose. However, one participant wrote a follow-up letter to the researcher, suggesting that a second interview may have been appropriate, as a way of addressing any issues that had arisen from the first interview. In consultation with her supervisors, the researcher contacted the participant by telephone, to discuss her experience of the interview and invite additional comments. The participant appeared satisfied by the conversation and the researcher’s explanation of the limitations of the study in terms of number of interviews, and there was no further contact.