ARTICLE IN PRESS

Social Science & Medicine 65 (2007) 2223–2234

www.elsevier.com/locate/socscimed

Informed consent, anticipatory regulation and

ethnographic practice
Elizabeth Murphy, Robert Dingwall
University of Nottingham, Nottingham, UK
Available online 20 September 2007

Abstract

In this paper we examine the application of informed consent to ethnographic research in health care settings. We do not
quarrel with either the principle of informed consent or its translation into the requirement that research should only be
carried out with consenting participants. However, we do challenge the identification of informed consent with the
particular set of bureaucratic practices of ethical review which currently operate in Canada, the US and elsewhere. We
argue that these anticipatory regulatory regimes threaten the significant contribution of ethnographic research to the
creation of more efficient, more effective, more equitable and more humane health care systems. Informed consent in
ethnographic research is neither achievable nor demonstrable in the terms set by anticipatory regulatory regimes that take
clinical research or biomedical experimentation as their paradigm cases. This is because of differences in the practices of
ethnographic and biomedical research which we discuss. These include the extended periods of time ethnographers spend
in the research setting, the emergent nature of ethnographic research focus and design, the nature and positioning of risk in
ethnographic research, the power relationships between researchers and participants, and the public and semi-public
nature of the settings normally studied. Anticipatory regulatory regimes are inimical to ethnographic research and risk
undermining the contribution of systematic inquiry to understanding whether institutions do what they claim to do, fairly
and civilly and with an appropriate mobilisation of resources. We do not suggest that we should simply ignore ethics or
leave matters to the individual consciences of researchers. Rather, we need to develop and strengthen professional models
of regulation which emphasise education, training and mutual accountability. We conclude the paper with a number of
suggestions about how such professional models might be implemented.
r 2007 Elsevier Ltd. All rights reserved.

Keywords: Ethics; Informed consent; Ethnography; Research; Regulation; Ethical review

Introduction research in sociology, with particular reference to

ethnography. Drawing upon our own experiences of
This paper discusses the impact of the concept of such research over the last 35 years, we consider the
informed consent, adopted in ethical review by most relevance of these regimes to the ethical dilemmas
anticipatory regulatory regimes, on qualitative which, in practice, confront ethnographers. We also
Corresponding author. Tel.: +44 115 9515403;
consider the threat of such bureaucratic regulation
to ethnography’s contribution to improving the
fax: +44 115 9515232.
E-mail address: elizabeth.murphy@nottingham.ac.uk efficiency, effectiveness, equity and humanity of
(E. Murphy). health services.

0277-9536/$ - see front matter r 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.socscimed.2007.08.008
 ARTICLE IN PRESS
2224 E. Murphy, R. Dingwall / Social Science & Medicine 65 (2007) 2223–2234

Ethnography typically involves researchers practices between the 1920s and 1950s, in both the
spending extended periods of time (sometimes a US and the UK, strengthened the case for the
year or longer) in one or more settings (for example, regulatory regimes that began to develop from the
a hospital ward, a general practice surgery, a mid-1960s (Beecher, 1959, 1966; Hazelgrove, 2002;
laboratory or an out-patient clinic) observing what Jones, 1981; Papworth, 1967; Rothman, 1993).
goes on, talking to members of the setting, However, these regimes are ill-suited to assessing
collecting documents and, on occasion, interview- ethnographic study proposals (Murphy & Dingwall,
ing. The researcher’s objective is to recover the 2003). This is neither because ethnographic research
‘situated rationality of action’—the ways in which, is free from ethical challenges, nor because such
in context, people’s actions make sense, even when challenges are unusually difficult or intransigent. It
they seem, to others outside the situation, to be is, rather, because anticipatory regulatory regimes
inappropriate or counter-productive. are based on assumptions derived from the model of
Studies of this kind have a long and distinguished clinical trials or biomedical experimentation, with
history in sociological research on health and health prior specification of hypotheses, design, instru-
care. Classic examples include Goffman (1961) on ments and implementation in protocols that are
mental hospitals, Glaser and Strauss (1965) on finalised before the study begins. In principle, this
death and dying, Becker, Geer, Hughes, and Strauss model is readily transferable to survey research,
(1961) on the professional socialisation of medical where it is possible to specify, in advance, exactly
students and Davis (1963) on the experiences of what a study will involve. This is not true of
polio victims and their families. More recently ethnographic research. In the rest of this paper, we
ethnographies of hospital wards (Allen, 1997), explore the ways in which ethnographic research in
responses to medical error (Bosk, 1979), paediatric sociology departs from the assumptions underlying
clinics (Strong, 1979), genetic counselling in a these regimes before concluding by considering the
children’s hospital (Bosk, 1992), care in private implications for designing appropriate regulation.
nursing homes (Diamond, 1992), paediatric inten- We should, though, first be clear that we have no
sive care (Anspach, 1992), emergency rooms (Tim- quarrel with the notion that research participation
mermans, 1999), the construction of disease (Mol, should be free from coercion. The concept of
2002) and medical examiners (Timmermans, 2006) informed consent is deeply embedded in liberal
have all made important contributions to our individualist assumptions about the virtue of
understanding of health care organization. autonomy and the priority of individual over
Ethnographies have a key role to play in creating community rights (D’Agostino, 1998; Wolpe,
a more efficient, more effective, more equitable and 1998). However, respect for persons, as operationa-
more humane health care system, particularly in lised through the practice of informed consent, is
illuminating the organizational and interactional only one of the three principles articulated in The
processes through which health care is delivered. Belmont Report (National Commission for the
They offer important information, to policy makers Protection of Human Subjects of Biomedical and
and practitioners, about factors that compromise or Behavioral Research, 1979) which underpins the
promote high-quality care, particularly the ways in subsequent development of Institutional Review
which well-intentioned actions may have unantici- Boards (US), Research Ethics Boards (Canada) and
pated negative consequences. Ethics Committees (UK). The other principles, of
The elaborate, bureaucratised, systems of ethical justice and beneficence, are equally relevant and
review currently operating in the US, Canada, UK may, in some instances, compete with the principle
and elsewhere threaten the survival of ethnographic of autonomy (Wolpe, 1998). Nevertheless, our
research with little gain in protecting research critique in this paper is neither of the principle of
participants. These anticipatory regulatory regimes autonomy, nor of its operationalisation in the
were developed for governance of clinical and requirement that research should only be carried
biomedical research, primarily in response to out with consenting participants. Our challenge is to
abusive experimentation in Nazi Germany revealed the identification of the principle with a particular
in the Nuremberg Trials (Annas & Grodin, 1992; set of bureaucratic practices more suited to biome-
Hazelgrove, 2002; Lifton, 1986; Schmidt, 2004; dical experimentation.
Weindling, 2004). The subsequent uncovering of Ethnographers do not universally share our
highly questionable clinical and biomedical research commitment to openness in research. Some reject
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the principle of informed consent altogether, de- biomedical experimentation as their paradigm cases.
fending covert methods and deliberately misleading This is because of fundamental differences in the
people about their research purposes (Douglas, practices of ethnographic and experimental research
1976). Others defend deceit in terms of the value that we now examine.
of the research findings. For example, Diamond
argues that the value of his exposé of the exploita- Extended periods of involvement in research settings
tion of nursing assistants and the erosion of patient
autonomy, privacy and dignity in three Chicago In ethnography, researchers spend extended
nursing homes justifies any wrong done to unwitting periods of time, often a year or more, in their
participants in his ‘undercover’ research study research setting. The practice of obtaining prior
(Diamond, 1992). If his employers had found out informed consent was developed in relation to the
that he was doing research, he would have been discrete episodic interventions typical of clinical
dismissed and unable to complete the study. Given trials or biomedical experimentation. Such inter-
the choice between abandoning his research and ventions lend themselves to the legalistic, contrac-
misleading staff and patients, he chose the latter. tual approach embodied in obtaining signed consent
The compromise of autonomy was, in his view, from research subjects prior to the start of research.
outweighed by the beneficence of the findings for In ethnography, consent is more likely to be
residents and workers. negotiated and renegotiated over time as the
Diamond is, however, in the minority among relationship between the ethnographer and the
contemporary ethnographers. Most, including our- research hosts develops (Adler & Adler, 2002).
selves, interpret the principle of respect for persons Although ethnographers have traditionally de-
as requiring us to conduct research as overtly as scribed the people involved in their research as
possible consistent with avoiding distress or disrup- participants or informants, we prefer the terminol-
tion to the settings we study. While deception may ogy of ‘hosts’ here because it better captures the
be ‘shaded in many different ways’ (Haggerty, 2004) nature of the relationship: ethnographers are guests
and, in research as in everyday life, the boundary in someone else’s setting and, like guests every-
between truth and deceit is often blurred, we are where, there are clear, if not always explicitly
wary of the argument that the ends justify the articulated, expectations of proper behaviour. The
means. Such judgements often depend too heavily status of guests is always fragile and depends on
on individual researchers’ estimation of the value of appropriate conduct towards their hosts, although
ends in which they have a heavy personal invest- this is not necessarily reciprocated.
ment. We also believe that the difficulties of Typically, at the start of such research, consent is
obtaining valid data using overt methods in even both tentative and limited and the researcher’s
very challenging settings can be exaggerated. There access to sensitive aspects of the setting may be
are numerous examples of ethnographers being restricted. Over time, as the trust between researcher
granted access to highly sensitive settings including and hosts develops, access may be granted to
the UK night-time economy (Monaghan, 2004), the previously restricted areas or interactions. However,
British Civil Service (Heclo & Wildavsky, 1974), the such access is rarely guaranteed and depends upon
Mafia (Ianni & Ianni, 1972), professional ‘fences’ the ethnographers’ capacity for sustaining the
Klockars (1974), professional criminals (Polsky, goodwill and co-operation of their hosts. Such co-
1971) and drug barons (Adler, 1985) (see also the operation can be, and sometimes is, withdrawn. At
discussions in Lee-Treweek and Linkogle (2000)). times, this may lead to the researcher having to
Moreover, covert ethnographers may underestimate leave the setting completely. In Dingwall and
harm caused to those they study, if and when they Murray’s (1983) work on child protection, for
discover they have been misled about the research- example, fieldwork in the A&E department of a
er’s real interest (Bulmer, 1980). Subjects of covert major university hospital was terminated when the
research may be harmed as well as wronged. junior doctors realised that Dingwall had observed
Our argument is not that informed consent is their, officially deviant, informal re-organization of
trivial or irrelevant. It is, rather, that informed their shifts to allow more of them to attend the
consent in ethnography is neither achievable nor hospital ball for at least some part of the evening.
demonstrable in the terms set by anticipatory More often, the researcher finds access to particular
regulatory regimes that take clinical research or aspects of the setting or its activities is restricted, as
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when, for example, the researcher is refused access friend or confidante becomes blurred and hosts may
to particularly sensitive meetings or areas within the disclose information that they do not recognise as
research setting. In his Ph.D. study of the training of relevant to the research but which the researcher
health visitors (public health nurses), for example, considers to be so. This raises questions about the
Dingwall (1974, 1977) was unable to observe one- extent to which the hosts’ prior consent justifies the
to-one tutorial meetings between the course staff use of such disclosures as data. In Dingwall’s (1974)
and students, which clearly played an important Ph.D. work, for example, he was invited to parties
part in the way that staff searched for, and thrown by members of the student group. Observa-
generated evidence of, student competence, because tion at these events was an important source of data
of the tutors’ concern for the students’ privacy in on the lateral life roles of the students, particularly a
receipt of criticism. number of conversations with women in their late
Ethnographic consent is a relational and sequen- 20s and early 30s about their prospects of marriage
tial process rather than a contractual agreement and or whether they would end up settling for a career in
lasts throughout the period of research (Katz & nursing. The study was strongly influenced by the
Fox, 2004). It is based on trust between researcher US work of Olesen and Whittaker (1968) on
and researched and is a matter over which research baccalaureate student nurses and of Psathas (1968)
hosts exercise ongoing judgement. The relationship on diploma students, where this tension had been
between the ethnographer and their hosts is more identified as a significant issue for understanding
akin to that of a patient with a general practitioner student commitment to their courses and intended
than with a surgeon. The patient gives tentative and occupation and these were clearly relevant data.
limited consent before contact with a general However, these were ‘off-duty’ occasions where
practitioner. Over time, as the relationship develops, some tongues were undoubtedly loosened by
the patient may agree to or solicit further contact, alcohol. In the end, Dingwall decided not to use
accept or reject advice as it is offered and, from time specific quotes, except for one instance where a
to time, agree to specific interventions. Mostly, student used a line from a popular song to describe
consent is implied rather than stated and operates her feelings about the impact of a number of
within a context where the patient may withdraw unsuccessful relationships. However, he did make
cooperation at any time. Unlike the anaesthetised general references to these observations and the
patient, the general practice patient surrenders sorts of conversations that occurred between him
relatively little autonomy. The same is true of most and the students, which seemed important evidence
ethnographic research, where successful execution for his discussion of the interactions between
depends upon establishing and maintaining a long- personal and professional lives.
term relationship of trust with research hosts (Bosk,
2004; Katz & Fox, 2004). Emergent research focus and design
Of course ethnographers do face ethical dilemmas
around consent. Indeed, some dilemmas are heigh- Since Nuremberg, there has been general agree-
tened by the extended periods that researchers ment between ethicists, regulators and scientists that
spend in the field and may be more nuanced and research participation must not only be voluntary
subtle than in the case of the discrete, episodic but also based on adequate knowledge and under-
interventions that characterise biomedicine (Corri- standing of the nature, duration, purpose, methods
gan, 2003). It is in the nature of ethnography that and potential hazards of the study. This has, in
researchers seek to minimise their own impact on practice, been translated into the requirement that
the settings they study. This reflects a concern, on the research participant give written consent, at the
the one hand, to reduce any disturbance or outset, based on a clear specification of the research.
inconvenience to hosts and, on the other, to avoid Clearly, it is not straightforward to determine what
distorting the setting and hence rendering findings is to count as adequate knowledge in either
unrepresentative. As researchers become integrated biomedical or social research. In both, the research
into the setting, they form relationships with hosts. is often embedded in highly technical and theore-
Over time, these hosts may come to overlook the tical concepts that may be opaque to potential
research purpose and the researcher’s identity qua participants. There are practical difficulties in
researcher begins, for the hosts at least, to fade into making explanations accessible to participants with-
the background. The line between researcher and out distorting the true nature of the research or, as
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Brewster Smith (1979) observed, ‘sending infor- which cannot be accommodated within a model
mants and cohabitants to graduate school’ (p. 14). that relies on fixing consent in writing at the outset.
Accounts that both biomedical and ethnographic Analysis of ethnographic data is an iterative
researchers give to potential research participants process where, typically, the researcher sets out with
are inevitably partial without necessarily reflecting a broad question to be investigated and the precise
any desire to deceive. Such accounts can never lines of analysis emerge as the data accumulate.
represent the simple, unmediated truth. Of neces- Again, this can be difficult to reconcile with the
sity, they will be designed for the audiences for requirement that participants are fully informed
which they are intended.1 Otherwise, they might be about the purpose of the research before it
true but incomprehensible. The adequacy of such commences. Some authors (e.g. Richards &
accounts is always a matter of judgement and Schwartz, 2002) suggest returning to participants
debate. at the end of the study to seek consent to use
However, ethnographic research confronts an findings once the shape of the analysis is clear. This
additional difficulty. In biomedical research, it is approach risks undermining the credibility and
normally possible to specify in advance precisely impartiality of ethnographic findings. There is
what the study will involve. In ethnography, both always the possibility that honest inquiry will
the research focus and the research design typically produce uncomfortable findings. To grant partici-
emerge during the course of the research (O’Neill, pants the power of veto invites them to suppress
2002). Consequently, the researcher is rarely able to findings they find unpalatable.
give a full account at the outset of what the research We believe that what is required is caution when
will involve, simply because she or he may not yet explaining the research at the outset. For example,
know. Flexibility of research design, and capacity to in a study of mothers’ experiences of feeding their
respond to insights emerging from early empirical babies and young children, Murphy described the
work, are distinctive contributions of ethnography, purpose of the study as ‘improving our under-
but complicate the process of obtaining prior standing of the choices which mothers make about
informed consent. For example, Murphy is cur- what, when and how to feed their babies’. This
rently researching the transition from children’s to inclusive formulation gave her team freedom to
adult services for young people with moderate to develop lines of analysis that had not been fully
severe intellectual disabilities. Gaining initial con- anticipated at the outset (Murphy, 1999, 2000, 2003,
sent to carry out this longitudinal research was an 2004, 2007). Similarly, Dingwall’s child protection
elaborate process involving the young people, their study (Dingwall, Eekelaar, & Murray, 1983) was
parents, social workers and health care providers as described as ‘an attempt to understand the workings
well as managers and supervisors. While the team of a system that was widely considered at the time to
was able to negotiate initial consent to the study be problematic so that its members and stake-
with each of these groups, it was not always obvious holders could consider how it might be improved’.
from the outset exactly what it would be useful to This second example highlights the importance of
observe or whom it would be appropriate to not being drawn into promising what we are
interview. Indeed, in some cases, it was only once unlikely to be able to produce. Not unreasonably,
the research was under way that they were able to research participants frequently base their decision
identify the key meetings, facilities and personnel. about whether to participate in research on an
Moreover, these changed over the period of the evaluation of the likely benefits to themselves or
fieldwork as new policies and systems were intro- others. There is often a temptation to over-claim the
duced and new appointments made. This necessi- potential contribution of a piece of research to
tated frequent negotiations and renegotiations, solving participants’ current problems. In this case,
the researchers avoided suggesting that the findings
would prescribe improvements in the child protec-
1
The situation is further complicated by the multiple audiences tion system. They made it clear that the contribu-
for such accounts. Such audiences sometimes include, for tion of the research would be to illuminate how the
example, lawyers who review consent documentation on behalf
current system works as a resource that policy-
of universities or publishers to identify any possible grounds for
legal action (Adler & Adler, 2002). As a result, there may be a makers and practitioners might use to identify
bias against plain English and in favour of legal dialects, which possible reforms. Thus, they maintained the bound-
may be as impenetrable as scientific ones. ary between the function of the researcher and that
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of the policy-maker and clarified what participants meaning researchers (Ellis, 1995). In a few extreme
could reasonably expect. cases, publication may put participants at risk of
legal sanction, which is particularly problematic
Nature, degree and positioning of risk in ethnographic because, in many jurisdictions, researchers have no
research legal protection from the obligation to disclose their
sources (Haggerty, 2004). However careful and
Giving potential participants ‘information on all respectful researchers are in their reports, they have
known foreseeable risks’ (Corrigan, 2003) is central minimal control over how these are taken up and
to the operationalisation of informed consent. The transformed by others, including tabloid journalists.
application of this principle to ethnographic re- Murphy had the experience of seeing the observa-
search is more complex than in biomedical experi- tion that a significant proportion of parents
mentation, where it is normally possible to specify reported giving their babies token tastes of alcohol,
and quantify risks in advance with reasonable for example by allowing them to suck a finger
precision. While ethnographic research is not risk- dipped in the Christening champagne, sensationa-
free, for either hosts or researchers (Lee-Treweek & lised under headlines such as ‘Tiddly tots’ and
Linkogle, 2000; Punch, 1994; Renzetti & Lee, 1993), ‘Alcoholic babies’ (Murphy, Parker, & Phipps
potential harm to hosts is usually different in (1998)).
nature, degree and positioning from that faced by The risks that exist in ethnographic research are
the subjects of biomedical experiments (Lincoln & highly indeterminate, subjective and not always easy
Tierney, 2004). Most commonly it involves psycho- to specify and communicate in advance to hosts
logical or social harm. Participants may be upset, (Bosk, 2004). In practice, there is often real
worried or offended during the fieldwork. For difficulty in persuading research participants to
example, the close relationships which develop engage meaningfully with such hypothetical risks.2
during ethnographic research sometimes lead hosts Their pre-conceptions influence their interpretations
to share information they find distressing or of whatever information the researcher offers. In
embarrassing to talk about, raising concerns about biomedical experimentation, it is usually possible to
the possible re-awakening of memories and conse- offer some actuarial assessment of the probability
quent re-victimisation of those who have experi- that risks will occur, but this is not the case in
enced difficult or traumatic circumstances. Like ethnographic research. Many potential hazards
most ethnographers, we have experienced such mirror those normally encountered in everyday life,
interactions in research, as in our everyday lives. and for which formal consent is not normally
Sometimes such disclosures appear to have been considered necessary (American Association of
therapeutic. At others, they may have been experi- University Professors, 2000; Haggerty, 2004). As
enced, in retrospect, as embarrassing or regrettable. Haggerty argues, there is a danger that the
However, it is unclear how any conceivable unpredictability and indeterminacy of risk may lead
application of the principle of informed consent to ethics committees applying the precautionary
could protect against such harm. In all cases, they principle in ways that make ethnographic research
appear to have chosen freely to share their troubles impossible, without any gain in protection for
with us even though they had not, we assume, participants. In such cases, as Alberti (2000)
anticipated doing so when they first agreed to our suggests, fulfilling one function of ethics committees
research. Bureaucratic practices are largely irrele- (protecting participants from harm) is achieved at
vant to such situations. The ethical challenge lies in the expense of the other (encouraging research that
ensuring that, in such circumstances, hosts are will improve health care). Nicholl (2000) argues that
treated with decency, discretion and respect, and when regulatory mechanisms become a barrier to
have access to whatever support they may subse- research that is ethical, this is itself unethical.
quently need. In practice, ethnographers are most likely to
Mostly, however, the point of greatest risk occurs identify risks to their hosts only in the course of
when research findings are published (Murphy & carrying out the project. Guillemin and Gillam
Dingwall, 2001). The reputations and relationships (2004) observe that it is in the day-to-day practice of
of hosts may be disturbed or damaged by publica-
tion. Hosts may be wounded by what is written 2
This is a difficulty that has also been reported in relation to
about them, sometimes in ways that surprise well- biomedical research (Morris & Balmer, 2006).
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research that ‘ethically important moments’ occur public resources or the impact of private interests on
and ethnographers are faced with the decision about the public sphere.
how they should respond. In such circumstances, Even where research hosts have less overt power
hosts are likely to be served less well by procedural than those discussed above, it would be highly
ethics embodied in regulations requiring fully unusual for the researcher to be able to exercise the
informed advance consent than by researchers’ kind of control that characterises experimenter-
conscientious commitment to avoiding exploitative subject relations. In ethnography, researchers typi-
and potentially harmful relationships with those cally adopt a passive rather than an active role.
they study. They are highly dependent upon the willingness of
hosts to act and speak within their sight and
Power in researcher/participant relationships hearing. Continuing data collection depends cru-
cially upon on-going cooperation from hosts and
Regulatory practices around biomedical research hosts who are uneasy about the research can
were born out of concerns about the possible obstruct or even terminate it in numerous ways.
exploitation of power differentials between re- Negotiating consent in ethnography is continuous
searcher and researched. To a large extent, the and constantly vulnerable to withdrawal. Partici-
resulting regulations model the researcher–re- pants have considerable capacity for controlling
searched relationship on that believed to prevail researchers leading, in extreme cases, to ethnogra-
between doctors and patients. The research partici- phers abandoning the research altogether. Dingwall
pant is taken to be passive, vulnerable and in need (2001), for example, recently sought to write a case
of protection and the researcher is understood to be study of a major scientific scandal as a problem in
powerful and capable of exploiting dependent organisational deviance and its management.
patients. Written informed consent in advance is Although much documentation was in the public
designed to mitigate this unequal power relationship domain, it soon became clear that the major
and protect the subjects’ rights during experimental research university where many of the protagonists
interventions where researcher control is intrinsic to worked was unlikely to co-operate, placing an
the research design. insuperable barrier in the way of funding the
This understanding of an asymmetrical relation- project. While the results would contribute to
ship between a powerful researcher and a vulnerable debates about research governance, and means for
research subject may be appropriate in relation to implementing this without stifling innovation, the
experimental interventions, where research subjects university’s leaders were more concerned with
submit to the researcher by surrendering their right resolving their reputational problems and avoiding
to self-determination for the duration of the further publicity, whether positive or negative, that
experiment (but see Morris & Balmer, 2006). Its might draw attention to their experiences.
relevance to ethnographic research, where power is
located differently, is less clear-cut. As Haggerty Public versus private settings
(2004) observes, while the imagined subjects of
social science research are the ‘poor and margin- A further uncertainty concerns the application of
alised’ (p. 409) who require special protection, this is the requirement for informed consent to public as
not always the case. Ethnographers often study opposed to private settings. Some ethnographies are
powerful people in publicly funded settings where conducted in settings which are open to the public
informed consent could be interpreted as a self- and where there is no expectation that presence or
serving requirement directed at protecting the status participation requires prior negotiation. Such set-
quo from interrogation and powerful members from tings are typically highly complex and mobile and
scrutiny. Research hosts are not invariably the this makes obtaining written, or even oral, informed
vulnerable and passive individuals imagined in consent from all who pass through impractical.
many ethics texts. There are real questions about Sometimes strict application of the requirement that
whether power brings with it an obligation to all those are the subject of research must give
contribute to improving knowledge, particularly in individual, fully informed consent would mean that
relation to the organisation and management of the ethnographer was so occupied in negotiating
public services. Ethnography is, in many instances, consent that she would have no time to carry out the
one aspect of public accountability for the use of research and would destroy the setting itself as an
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object of study. A number of authors (Adler & that it is not clear whose interests obtaining consent
Adler, 2002; Haggerty, 2004; van den Hoonaard, actually serves. Elsewhere, Dingwall (1980) has
2002) report how, in such circumstances, ethical distinguished between ‘principals’ and ‘spear-car-
review boards’ preoccupation with obtaining in- riers’. In the child protection study, for example,
formed consent has made conducting otherwise consent was not sought from families involved in
unexceptionable studies impossible. the candidate cases that were tracked through
Such restrictions threaten to extinguish research the network of agencies in the main study site.
in public spaces, with consequent loss of important For this study, they were ‘spear carriers’ because the
data about social interaction and practices. It is project’s focus was on how cases were co-produced
unclear why researchers’ observations of behaviour by professionals and agencies. Parents’ accounts
in public spaces should be controlled in this way or were irrelevant to this and they were not interviewed
how such restrictions protect those observed. People as a result of a deliberate decision not to generate
in public spaces knowingly make their behaviour ironic data. Agency decisions were based on what
available for scrutiny by anonymous others— staff deemed to constitute evidence and their
British cities are full of CCTV systems continuously mutual assessments of its adequacy for justifying
scrutinized by a variety of law enforcers, for various courses of action. These data were
example. In that sense, people’s consent to being embodied in official records, internal and inter-
observed is implied by their simple presence. Why agency review meetings between professionals and
should ethnographers be subject to more stringent court hearings. The people involved in these were
requirements in this respect than other citizens or the ‘principals’ whose consent was carefully nego-
surveillance agencies? That said, even public settings tiated. Clearly, one could envisage a project where
have private moments and researchers have an these roles are reversed, where parents’ stories
obligation to treat such moments with respect and are the object of interest and child protection
decency, which may well require them to adopt a professionals are the spear carriers. In such a case,
self-denying ordinance when faced with what might the negotiation of consent would necessarily be
otherwise be relevant data. Once again, this requires inverted.
the kind of ethical sensitivity and situational
judgement that cannot be enforced by anticipatory Discussion
regulatory regimes.
However, many settings ethnographers study are Anticipatory regulatory regimes that transfer
semi-public rather than public and, it may be models of consent from clinical or biomedical
unclear from whom consent is required. Whereas research to ethnography are highly problematic.
biomedical and interview research focus on indivi- Approaches currently adopted in the UK and other
duals, ethnographies typically involve extended developed countries are erecting insuperable bar-
observations, for example in hospital wards or riers to ethnographic work or creating such disin-
outpatient departments. The population is often centives that scholars are choosing not to do it. This
highly transient and it is not always obvious who presents us with a stark choice—a choice that hinges
should be classed as research participants. If, for upon whether or not we believe that ethnography
example, the focus of the research is on nurse has anything to offer to the creation of a better
behaviour on a particular ward, one clearly needs to society, or, at least, to the more efficient, effective,
seek consent from the nurses. But what about all the equitable and humane use of resources in the one
other people who are based on or pass through that that we have. Do we accept the disappearance of
ward? How far does that extend: to doctors? to ethnographic work or do we revisit the models of
cleaners? to patients? to maintenance staff who regulation that have been imposed on the social
make a one-off visit to the ward? During extended sciences?
periods of observation, ethnographers will have We happen to believe that ethnography has a
many casual encounters with people who pass vital role in examining the extent to which institu-
through. Once again, if the setting is not to be tions do what they claim to do, fairly and civilly and
disrupted, and the research is not to be impractical, with an appropriate mobilisation of resources. It is
one must distinguish between those for whom the the gold standard for the study of processes, a study
research is likely to be consequential and those who that is as important for policymakers and practi-
are tangential. Often the risk of harm is so minimal tioners as the study of outcomes (Murphy &
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E. Murphy, R. Dingwall / Social Science & Medicine 65 (2007) 2223–2234 2231

Dingwall, 2003). If this is accepted, then a Ethical conduct of ethnographic research ulti-
regulatory regime that is inimical to such research mately depends upon the personal integrity and
will replace systematic knowledge with systematic ethical education of the researcher. It is simply not
ignorance and undermine the democratic account- possible to write an unambiguous set of rules for
ability of major institutions operating in or imping- conducting such research or fully to evaluate
ing on the public sphere. Neither seems a proposals in an anticipatory process. During
particularly ethical consequence of ethical regula- extended fieldwork, unanticipated ethical dilemmas
tion. In effect, autonomy once again trumps both will arise and require immediate resolution. Increas-
justice and beneficence as well-intentioned actions ing bureaucratisation of such research through what
bring about negative outcomes. Haggerty has called ‘ethics creep’ risks undermining
There are two further considerations. The first is a the moral and ethical responsibility of the very
reasonable assessment of the actual risks involved in researchers it seeks to control. When ethics becomes
observational research. Faced with the need to institutionalised, rule-following replaces a commit-
estimate, in advance, potential harm, researchers ment to working out the ‘right thing to do’ as
and regulators find themselves anticipating hy- researchers negotiate the complex moral territory of
pothetical worst case scenarios with little attention fieldwork. The danger is that researchers will come
to the empirical evidence of the likelihood of the to see satisfying the demands of ethics committees
worst case actually occurring. In reality the risks to as the be all and end all of ethical practice.
participants of observational research do not begin None of this is to suggest that we can simply
to approach the risks inherent in most forms of ignore ethics or leave it to the consciences of
clinical or biomedical experimentation. individual researchers. The good reputation of
The second is that, if academic researchers are no social scientists is critical to the institutional
longer able to conduct observational research, this legitimacy and public standing of our disciplines:
does not mean that such investigations will not take unethical behaviour by one member of our com-
place. They will simply be done by our rivals as munity may compromise society’s support for us all.
cultural commentators (Strong, 1983), other writers Given the ever-increasing institutional pressures on
and journalists, working with different kinds of individual researchers to increase productivity, the
motive and subject to different ethical principles— temptations to ride rough-shod over ethical practice
relatively free of regulatory constraints. Although are very real. Some kind of regulation is both
journalists can be sued after the event, prior inevitable and appropriate. However, the current
restraint is difficult to achieve. There are many system of anticipatory, bureaucratic regulation is
examples of such investigations—and not only by not an effective means of ensuring ethical research
tabloid journalists. Serious writers and investigative practice in ethnography.
journalists undertake what amounts to covert It is time to reclaim research ethics from the
research, justified by appeals to the public interest bureaucrats. We need to develop and strengthen
on the one hand and to the freedom of the press on ‘professional’ models of regulation—albeit in an
the other (e.g. Ehrenreich, 2002; Orwell, 2003; environment that is, at least temporarily, hostile to
Toynbee, 2003). Regulation will not stop observa- professions. Such models would emphasise educa-
tional work, but simply ensure that it is done by tion, training and mutual accountability. They
people outside its jurisdiction and unconstrained by would place more weight on the promotion of
the standards of scientific rigour expected of sound ethical behaviour than upon pre-empting
academic researchers. A few academics may use unacceptable behaviour through anticipatory bu-
their own life experiences in the form of auto- reaucracy. Such professional models might include,
ethnographic accounts, but these are notoriously for example, a stronger emphasis on ethical discus-
unsystematic and unrepresentative, although they sion in basic research training. We might consider a
may usefully identify potential areas for further system of accrediting or licensing principal investi-
work (‘‘Locus Congressi’’, 2006). Policymakers, gators and research student supervisors based on
professionals and citizens will be forced to rely the completion of training in ethics and subsequent
upon less robust findings as a basis for improving evidence of continued ethical engagement and
the public sphere, since rigorous research will have awareness. Accredited individuals could be ex-
been forced out by the perverse effects of antici- empted from external review except in cases where
patory ethical regulation. there was significant risk of harm to research
 ARTICLE IN PRESS
2232 E. Murphy, R. Dingwall / Social Science & Medicine 65 (2007) 2223–2234

participants or a proposed project raised particu- observed. Reasserting the professional responsibil-
larly contentious issues. ities of reviewers and examiners could be expected
There are a number of potential strategies for to increase the awareness and sensitivity of
accomplishing this. One would place institutional researchers to ethical dimensions of their practice
ethics committees at the centre of the accreditation by highlighting their mutual accountability to their
process. Freed from the excessive workload peers.
arising from the current bureaucratic model of There is, of course, no reason why any one
prospective consideration of all projects, ethics strategy for regulation should necessarily have a
committees might also find time to monitor research monopoly. Researchers might choose to seek
practice in institutions, possibly through a accreditation through disciplinary associations
‘dip-stick’ approach to reviewing projects that where these have a strong identity, as in psychology,
are currently underway or recently completed. or to opt for an institutional licence, particularly if
They could also consider complaints from those they are working in a new or interdisciplinary field.
who believe that they have been the butt of To some extent, competition between accrediting
unethical research practice. Ultimately, ethics com- bodies would serve to keep over-reaching in check,
mittees could have the power to suspend the since a licensing regime that was too burdensome
accreditation of investigators and supervisors who would simply lose clients to one taking a more
are deemed to have engaged in unethical research liberal approach.
practices. Current approaches to the governance of ethno-
However, given their record of bureaucratic graphic research are simply not fit for the purposes
excess, it may be better to explore more traditional for which they are intended. We have identified a
models that would place accreditation in the hands number of characteristics of ethnography that make
of the relevant professional communities. Ferlie and anticipatory regulation inappropriate. This is not a
Geraghty (2005) have noted the failure of confron- problem that can be solved simply by tinkering with
tational regulation to achieve bureaucratic domi- the current approach to such research by ethics
nance over professionals, resulting as it does in committees. It requires a root and branch re-
implementation deficits and, often, the delegitima- thinking of ethical regulation, and a reassertion of
tion of the regulators in the face of public trust in the continuing value of professional self-regulation
the professionals. Nevertheless, the problem of and mutual accountability.
accountability for expertise remains. In the light of
experience, they argue that traditional forms of peer
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