Step 1: Facts

• There is a disease-causing pathogen only found in a small region of Lesotho 
• The testing is simple, but the trip/equipment will cost money, and community assistance is required
  • We are studying the life cycle/characteristics of a certain pathogen
• Characterizing pathogens can help further research into how to make water safer to drink
• We are expected to write some publications on what we find from our research
• We assume that the pathogen truly is present in some/all of their water sources
• We assume the people in Lesotho know where all water sources are and that there is not risk of further water contamination 
• Lesotho is endowed with abundant water resources, and after the passing of the Water Act in 2008, they are also very conscious about the “management, protection, conservation, development and sustainable utilisation of water resources”.
• We also assume we have received IRB, and all other necessary approvals to conduct research. 

Ethical Issue: 

• Is this study just an example of hit and run research or does this research actually help the people of Lesotho? Does the study have social value in general?
• Balance between ethics and rigor, not doing study rigorously enough is an ethical issue too as our mission is to characterize the pathogen effectively and correctly

Step 2-3: Define the Stakeholders/Assess Their Motivations

• Researchers -> academic clout😤😤😤, maintain jobs, create positive impact through their research/findings
• The University of the Academics -> maintain their reputation globally, advancing knowledge & delivering value to society
• Villagers of Lesotho -> obtain clean water supply, stay healthy, not have their lifestyle completely disrupted, lower risk of contracting disease, building connections and relationships, possible economic development w/ cleaner water in tourism and exporting water to South Africa
• Funders/Government Agency -> stake in developing an additive or water cleaning system, obtain more grants for future work, research might help their projects and development, creates a positive image of corporate social responsibility, develop their brand in this area
• Healthcare System/Providers in Lesotho -> less burden from waterborne diseases, more resources to devote to other conditions
• Academic Journal -> acquire new research (groundbreaking) that adds to general knowledge of pathogens, build reputation

We want to build a relationship with the locals. We are trying to negotiate entry to conduct future research in this community.

Step 4: Solutions

• Conduct experiments on how the pathogen affects health. Experiments would include testing the water with pathogens on rats. 
• Select guides which are knowledgeable of water sources, probably village women
• Test water from multiple sources; in villages with different socioeconomic statuses in order to make the study as just as possible
• Only collect the water samples in vials when doing field work; test the water later in labs to avoid contamination and disruption. 
• Educate the villagers of Lesotho about your findings while you are there about things they can do in their capacities & after the water has been tested, help them towards finding a solution to any disease-causing pathogens you found
  • Sharing information and results that would benefit the people of Lesotho (and those downstream of Lesotho) after the research gets published. Do not put the publication behind an expensive paywall, make it accessible to those in Lesotho.
  • Email the papers to the heads of communities to show that something came out of the research they assisted in.
  • Maximizing clinical value & making sure there is positive social impact/return

• Identify the source or the pathogen and how it is contaminating the lake.
• Conduct simple examinations on locals to identify symptoms and effects from drinking the lake’s water. 
• Once completing testing, drink the water to prove to civilians the water is safe.
• Attempt to provide a temporary cleaning solution or import purified water to the communities
• Request the right to access the water sources from legislation/leaders of each village while being conscious of any cultural practices/norms.
  • Appeal to community health workers in Lesotho who can help the community understand your work 
• Negotiate some way to incentivize the community, materially or immaterially, addresses the issue of beneficence, perhaps with some clean water solution.
  • Ensuring that you do the study right, focus on legitimacy

Pros: Working with the community, broadening knowledge of pathogens, potentially helping them in future and developing relationships, will allow for successful testing for the pathogen, helping us and the communities of Lesotho.

Cons: Not reporting back to them with enough information on our findings, they may not want to help us if we do not properly compensate them, process of requesting access to the water in Lesotho through the government may take longer than we anticipated, the community members in Lesotho have the right to turn us down (our funding sources would be mad).

Ethical Principles: The research is mostly consequence-based thinking because it is focused on discovering more about this pathogen to help people globally. However, our steps to request access to the water sources in Lesotho bring a more duty and virtue based approach because we are trying to get their approval, work with the community members, and hopefully bring back new information to them to help in the future. From a purely utilitarian perspective on face value, this seems like a worthwhile venture as we can make a crucial discovery, while helping those in Lesotho. It will be crucial to our reputation and our stakeholders that we do not conduct a hit and run research trial.

Step 5: Seek additional assistance, as appropriate

• NSPE Code of Ethics: This legislature enforces that engineers “hold paramount the safety, health, and welfare of the public” in their work. Hence, an engineer need note this when debating the ethics of this study.
• Who has approved the study? The university? Has it received IRB approval?
  • IRB Ethics:
    • Social or Scientific Value
    • Scientific Validity
    • Fair Subject Selection
    • Favorable Risk – Benefit
    • Independent Review
    • Informed Consent
    • Respect for Potential and Enrolled Subjects

We, as the researchers, believe that we fulfill all the requirements of the IRB Ethics protocol and can conduct meaningful research in Lesotho.

• Belmont Report 
  • Beneficence
  • Respect for persons
  • Justice
  • Protection of anonymity if desired

Step 6: Select the best course of action

Unlike the first case study, the best course of action here is not as simple as including the auto-disabler or scrapping it (with some added decisions for manufacturing and distribution). To conduct this study ethically, we have to ensure we follow the right protocols from start to finish.

• First, we have to ensure we only test in areas in which we have been granted access to and explain the benefits for society and their community in a culturally appropriate manner.
• We also need to describe to the villagers what we are doing and educate them on the risks/potential solutions while keeping CHWs informed of our progress. Integrating an educational aspect is a requisite for conducting this study. 
• In the short term, we will give them clean water sources and show them how we do our research. 
• In the long term, we are going to present them our findings and give them a solution to keeping their water clean and safe. We will be able to do this by maintaining a close relationship with Lesotho. 
• Finally we will conduct our research from several lakes in several areas with the help of willing community members, and not put any substances in their water sources so as to not violate the Water Act and other Lesotho water sanitation laws.
• We will take the water in vials to test elsewhere in a lab in-country.

This framework limits most of the listed ‘cons’ while fulfilling IRB ethics and the Belmont Report guidelines. The most glaring downside to this is the fact that the villagers of Lesotho may want more say in the testing protocols, while we would rather stick to our plan. However, we are willing to listen to ideas they have in order to make the testing more efficient. Our compensation should alleviate the second most glaring con.

Step 7: Venture Implications

• Improving community health by treating the water 
• Opportunity to market water treatment/cleaning solution to Lesotho and surrounding communities
• Adding to the global knowledge of this pathogen, and similarly structured ones.
• Potential positive or negative environmental implications if water treatment solution is derived from this research and introduced to the community
• Potential employment/volunteering of locals into protecting the lake and working with our venture apply our solutions.