Mothers and young children in Mali

WHO/TDR/Crump

Clinical trials and medical research are essential to the progress of science and to improve world health. To undertake such research ethically, with the informed consent of participants, scientists must understand the cultures and communities they are working in.

In this essay in Science, Ogobara K. Doumbo discusses research ethics in the context of his own medical career in Mali. He argues that it is just as important for scientists to interact with trial participants in a respectful, compassionate way as it is to follow standard ethical conventions.

A framework for medical ethics used in developed countries cannot, however, be transplanted, unchanged, into a developing country, says Doumbo. Notions of autonomy, for example, differ between the two. Thus, in the developed world, individual consent would be sought for participation in a trial. In close-knit communities in African villages, Doumbo explains, community consent is just as crucial, and should be requested before the individual is approached.

In western countries, written consent is usually required of trial participants. In Mali, though, more than 80 per cent of the population is illiterate. Not only that, says Doumbo, but locals often feel that verbal consent or 'giving their word' should be sufficient.

Doumbo urges funding agencies and developed world institutions to understand these sorts of issues when considering research in a developing world.