Case 13: The Suspect Questionnaire

While setting up a study of interaction between physicians and parents of critically ill inner-city children, a young anthropologist contacted the chair of the Department of Pediatrics of the medical school affiliated with her university. During a discussion of the prospective study, the researcher mentioned that she was working on an interview schedule for parents. "Something like this?" queried the physician, handing her a first-rate questionnaire for parents of sick children. Wishing to contact the author, the anthropologist questioned the pediatrician, who became evasive and refused to discuss the matter. Subsequently, she received three different copies of the same questionnaire from friends who knew of her study; all were traced back to the same physician. His secretary then told the researcher that the schedule came from a National Institutes of Health (NIH) grant proposal for which she had typed his unfavorable review (the anthropologist was unable to substantiate this information). Unable to reach its author, the researcher did not use the questionnaire. Was there anything else a powerless junior researcher could do to deal with distressing, and possibly unethical, behavior on the part of a powerful senior physician?

Comment

John C. Fletcher, Assistant for Bioethics, Office of the Director, Clinical Center, National Institutes of Health:

This case may be about the three most common violations of ethical principles: lying, cheating, and stealing. (I say may because it is open to question whether in fact the physician had obtained the questionnaire from an NIH grant proposal.)

The first consideration is to whom in authority the anthropologist should turn for help in clarifying what happened. The first moral choice is whether to ask for help from those in authority who have the legitimate power to discover the facts. If authorities have created an open climate for such actions, asking for help is easier. How the anthropologist goes about seeking help will also affect the outcome. She should first write an account of what happened and the questions she needs to have answered. In fairness, she can give the chair of the Department of Pediatrics a copy, with a message that she deserves his cooperation, or else she will go to a higher authority (e.g., the dean of the medical school faculty) to resolve the ethical questions provoked by his behavior. The anthropologist then needs the help of her own department chair to convince authorities that special action is required. It is not the task of the anthropologist to investigate the physician's ethics; it is her task, however, to refer the matter to authorities effectively and fairly.

Let us suppose that the physician did obtain the questionnaire from a grant proposal. To take and use improperly another's work is theft. Moreover, when queried about the author's identity, the physician evaded an answer. The young anthropologist is neither enemy nor adversary; she is a colleague, a member of the same university faculty. Withholding information owed to another with whom one is bound in relations of fidelity and duty is a form of lying. Finally, to gain an advantage by dishonest means Is to cheat. The physician was in the role of grant reviewer when he first saw the questionnaire. This role does not grant a license to use the author's material without permission but only to make a judgment about its validity and fitness for the proposed study. Having stolen the document, the physician is then able to portray himself as the all-provident helper of young researchers with just the right instrument at the right time.

My thesis is that just because unethical behavior takes place at a high level does not excuse us from attempting to prevent its recurrence. If the facts turn out to be against the physician, several steps must be taken. The NIH should be notified, because a breach of rules for reviewers has occurred. The anthropologist should be thanked for bringing the matter to light. Finally, the true author of the questionnaire should be notified and offered an apology.

The NIH Division of Research Grants has explicit rules for reviewers that stress the confidentiality of grant documents and protect the research ideas of applicants. The clear-cut application of a research method or instrument, as in this case, is a violation of ethical conduct for a reviewer.

Were the suspicions of the anthropologist truly unfounded, with the physician being in fact the author of the questionnaire, a wise physician would thank the anthropologist for bringing up the matter, so that questions about his ethics would have been answered. Everyone needs moral criticism. Without it, we become distanced from colleagues and the rules that protect us from aggression and dishonesty.

Comment

William F. May, Southern Methodist University:

The case reminds one of the story Nathan the prophet told King David, after learning that David has taken to bed the wife of Uriah the Hittite and sent Uriah off to battle where he is sure to be killed.

A rich man, Nathan says, once took the sheep, the only sheep of a poor man, instead of one of his own large flock, to feed a hungry man. David grows righteously indignant at this high-handed abuse of power and vows to punish the rich. Nathan turns on the king and says "Thou art the man."

The powerful professor in this case helps out the needy young anthropologist and perhaps several others--by conveying to them not work of his own, but a questionnaire which he has poached from the work of another, work which he considered good enough to take but not to support.

What can the "powerless" junior researcher do? First, just how powerless is she? Admittedly, she is junior; she works in the same university; and, as a specialist in medical field research, she may not be able to afford enemies on turf to which she needs access. Further, the university apparently has not regularized judicial procedures for reviewing such a case. She clearly lacks the power to subject the physician to external sanctions or to institute the machinery for such sanctions.

But, beyond that, she is not utterly powerless or wholly vulnerable. The physician, after all, is not her boss. She enjoys more independence, even as a junior member of the university staff, than, let us say, Nathan does as a member of David's kingdom or Moliere's uppity housemaids do toward the lord of the household. If she acts by confronting the physician directly with her worry, she does not automatically subject herself to martyrdom.

In the absence of judicial procedures, she just might muster the courage to assume the role of an academic Nathan or a Dorine and talk to him directly.

Failing that level of moral courage, she might take care not to yield to the other temptations that beset the outraged and powerless: disillusionment, cynicism, and a subtly growing obtuseness about one's own behavior that eventually may prompt a young, powerless, but braver junior colleague to step forward much later on another matter and say to her, as a senior professor, "Thou art the woman."