Step 1: Determine the facts in the situation

1. There is a unique disease-causing pathogen only found in water sources in Lesotho
2. A team of ten academic researchers will be travelling to communities in Lesotho for two weeks
3. Assistance from community members is required to understand where the water comes from and places/methods for storing the water
4. The goal of the research is to understand the life cycle and characteristics of the pathogen
5. Several publications are expected
6. A more thorough understanding of the pathogen may allow for the development of chemical additives that could make the water safe for drinking

The ethical problem: Is the participation of the community members ethical? Do they need to be compensated for their participation? How should they be compensated? Which individuals should be chosen to participate? How should they be chosen?

Steps 2 & 3: Define the stakeholders and identify their motivations

1. Researchers
   1. Understand the life cycle of the pathogen
   2. Disseminate the newfound knowledge to the greater academic community

• Possible personal motivation to help the community (?)
  1. Likely not primary motivation for research

1. Meet their funders’ expectations/deadlines.
2. At a personal level, one research may be driven by selfless goals, but others might be driven just by the professional aspect of it (e.g., getting their paycheck, obtaining an advanced degree)

1. University
   1. Wants to be represented well (i.e., positive publicity), increasing reputation
   2. Advance the research, write manuscripts,

• Be involved in a major breakthrough for solving a healthcare problem.

1. Funders
   1. Wants to be represented well (i.e., positive publicity), increasing reputation
   2. Advance the research, write manuscripts,

• Be involved in a major breakthrough for solving a healthcare problem.

1. Community members
   1. Eliminate the pathogen in their water supply
   2. Build relationships with foreigners

• Risks: community members may tell you what you want to hear; may be overly helpful to the point that they gain nothing from the interaction; may not want to acknowledge existence of disease

1. More tourism if water is cleaner, which would grow local economy

1. Government bodies
   1. Improve public health
   2. Decrease cost for health care

• Forge partnerships with the university

1. Increase knowledge of local pathogen harming their water
2. Learn how to develop education/prevention programs.
3. If Lesotho exports their water to South Africa, they would be interested in receiving the research to be completed and possibly improve the quality of their water.

1. Academic Journal
   1. Further general body of knowledge
   2. Develop positive publicity for their brand

• Establish prestige

Step 4: Formulate three alternative solutions

1. Conduct the research as it is
   1. The researcher is not obligated to solve the problem directly
   2. Simply publishing their research will allow other, more well-equipped, entities to address the problem and implement it in the most culturally appropriate manner

• No compensation for community members is necessary because the future benefits to the community resulting from the research will be adequate

1. Volunteers will assist the researchers

1. Schedule an audience with the local authority
   1. Ask authority to call a town meeting to recruit individuals
   2. Provide community members with all details of the study
      1. What you’re studying, why you’re studying it, what help you need, the qualifications of the ideal individual to help, the anticipated time commitment, the compensation

• Community members who are selected will be compensated with a meal during the time which they are helping the researchers

1. Educate community about pathogen and provide temporary solutions for avoiding the associated diseases
   1. Tangible compensation is not necessary
   2. Providing the community with an interim solution is sufficient

Step 5: Seek additional assistance, as appropriate

Additional assistance could be sought from local academics or professionals that would have the knowledge and connections necessary for a smooth entry. By partnering with groups or organizations already addressing the effects of the pathogen on the community, the researchers could more confidently promote a future solution for the towns.

Step 6: Select the best course of action

Solution A assumes that the study is inherently ethical because there is no harm done and the solutions resulting from a better understanding of the pathogen will be enough benefit. Solutions B and C both increase the ethical nature of the study, so I believe the best course of action is a combination of all three solutions. Combining all of these solutions provides the most good because community members are being compensated for their participation, the researchers will get the most accurate data from the best-suited individual, and the community will have new strategies to handle the pathogen. Compensating the individuals that show the researchers the water sources is a generous (virtuous) thing to do and will maximize the total benefits of the interaction for the locals. Even though the study is ethical without compensation, the financial cost to the researchers is low and increases the benefit to the community members. By combining the solutions, the motivations of the researchers and the locals are achieved directly, but this course of action also indirectly meets the motivations of the other stakeholders. Asking the community to select the best-fit individual to identify the water sources will ensure the study is successful, which will satisfy the university, the funders, and the academic journal. Additionally, educating the locals so they are able to minimize risks associated with the pathogen until a more permanent solution can be developed increases the benefit to the community. The researchers are assumed to be already educated about the pathogen to an extent, so sharing the knowledge with the community would be simple and beneficial.

Step 7: What are the implications of the solution?

By compensating the locals, some monetary cost will be incurred. A courtesy meal as compensation will allow the community members to build relationships with the researchers and the associated cost will be small. By compensating the community, a better social relationship will be developed. This will make it seem less like a “hit and run” study that just exploits the suffering community for the benefit of the researchers.