Introduction

The field of ethics is a vast arena with multiple possible traditions, dimensions, and levels of analyses. Kitchener and Kitchener’s (2009) model presents five levels: from the highest level of more abstract and paradigmatic meta-theories, to the lowest level of particular behaviour and single cases, with three intermediate levels—ethical theories, ethical principles, and ethical rules that operate according to professional codes. The levels are inextricably connected: ethical theories shape institutional codes of ethics which, in turn, are used to give form to ethics in practice. Ethics in practice, also referred to as ‘applied ethics’ (Cecchini 2019) uses principles and insights from normative ethics and abstract theories to deal with concrete problems that arise in the course of any research. Such models can provide rationales and more precise contexts for framing questions and uncertainties during research practice, even when some of those questions remain unanswerable.

In this Field Notes, I will relay some ethical tensions at the single case level—in this instance, ethnographic fieldwork focusing on sensitive topics with ‘vulnerable populations’—relating these situations to broader ethical frameworks. Through mistakes, omissions, blunders—in this essay, I share reflections of such faux pas committed during recent years working and researching with social groups affected by many different forms of injustices. I address the challenges these concerns pose to anthropological research and reflect upon them within broader ethical frameworks.

Ethics in practice: Sensitive topics and ‘vulnerable’ populations 

Because of the unexpected, evolving, and complex nature of social life, ethical dilemmas in research may be infinite, and could hardly all be answered following a priori, fixed ethical protocols. When research includes ‘vulnerable populations’—groups who have been historically disadvantaged in terms of socioeconomic status, ethnic background, gender, or disability, among others—such ethical dilemmas need to be carefully addressed due to the potential to cause more harm. 

But who exactly are ‘the vulnerable’? In ethical guides and declarations—most of them relating to biomedical research (e.g., the Belmont Report, Ethical Guidelines of CIOMS-WHO, the Declaration of Helsinki, and so on)—vulnerability is defined as applying to people who, by virtue of a shared characteristic, deserve special protection in the context of biomedical research (Santi 2016). This is the sub-population approach to the vulnerable; ‘the label metaphor’ (Luna 2009) that assumes a baseline standard for a default paradigmatic research subject, based on an idealisation and simplification of this category. Theories rooted in non-mainstream models of ethics (including feminist, anti-racist, communitarian, and transformative models) address the limits of such a perspective that contributes to exacerbating vulnerabilities and instead call for context-dependent and theoretically-driven concepts. 

Goodin (1985) suggested that these social groups cannot protect their own interests and are at higher ‘risk of risks’ (Frolich and Potvin 2008, 216). Liamputtong (2007) offers a definition with regards to identifying ‘the vulnerable’: this includes social groups who have an increased relative risk or susceptibility to adverse health outcomes; stigmatised people; those susceptible to coercion or undue influence; and those that experience unequal power relations. These, among other characteristics, require special care from researchers. I draw upon this definition of the ‘vulnerable’, which is inextricably linked to broader structural and cultural dynamics, as addressed elsewhere by the concept of ‘structural vulnerability’ (Quesada, Hart, and Bourgois 2011).

Faux pas in a dumpsite study (2016–21) 

My reflections in this Field Notes are derived from five years of community-based research on a garbage dump in Paraná, the capital city of the province of Entre Ríos, in Argentina. The research project focuses on social inequalities and health disparities in socioeconomically and culturally marginalised communities: in this instance, a group of waste-pickers and their families. The goal was to analyse how social practices of people making a living (Narotzky and Besnier 2014, S14) in an open-air garbage dump, and the structural patterns of segregation of neighbourhoods, were overlooked social inequalities which also related to disparities in the cancer control and care continuum for this community. Across three research cycles, a wide combination of methods was used, primarily ethnography, collaborative ethnography, and audiovisual methods. The research was supported by the University of Buenos Aires and the National Cancer Institute. 

In what follows, I will zoom in on three particular ethical tensions that emerged during this fieldwork amongst waste-pickers. The first relates to the exclusion of certain narratives; the second, to the hidden suffering associated with vulnerability and the dangers of causing harm; and in the third, I emphasise the risk of stereotyping the ‘vulnerable’ when including audiovisual methods as a research tool.

Voices excluded 

This group of waste-pickers making a living in a dumpsite suffer from a number of adverse conditions: exclusion from the formal labour market; socioeconomic deprivation; residential neighbourhood segregation; poor housing quality; a lower quality of educational and health services than other citizens; and exposure to toxic substances and hazardous conditions. During fieldwork, oppression came to the fore in people’s narratives and observations of their daily activities. The research team of which I was part described the phenomenon, examining most closely the male waste-pickers’ world. This included what they collected, the strict codes they have to respect (including the designation of specific spaces within the garbage dump for collecting activities), and the specific physical routes for selling and distribution.

However, after a while, we realised that we had failed to address and attend to many other voices that also were there, albeit coming from a more marginal position and, thus, from less visible places: the voices of women, adolescents and children, and recently arrived migrants. Each of these groups also inhabited the dumpsite—also scavenging, but at night and in much riskier locations within the dumpsite than the male waste-pickers we interacted with. The area used by these other pickers was close to the ‘heart’ of the dumpsite, a ring of fire associated with spontaneous explosions of methane gas that occur deep inside this 300 m² garbage dump.

To disentangle such omissions, we reflexively considered the whole fieldwork process as it had proceeded up to that point and the changes we needed to make to it. We drew upon relational feminist ethical theories (Noddings 1984) that question epistemological assumptions: the ways of presenting the research to the community and ‘recruiting’ informants, where only the more visible people belonging to the garbage collection networks had come forth; our own position in reproducing inner power hierarchies; and the emotional work (Cecchini 2019) of managing the initial impact we felt of this new world that we saw opening up to us. This new direction led us to identify women and less visible groups of people also living and working in the dumpsite. We included a collaborative cycle or phase— ‘collaboration’ in terms of defining areas of mutual interest and partnerships with members of the communities involved, as practised in the action research tradition (McNiff 2013)—to address these groups’ perspectives and priorities. In addition, as the team ethnographer, instead of conducting formal interviews I chose to maximise my immersion in the field, including spending weekends and night-times at the dumpsite, which enabled me to reach deeper levels of proximity with previously undetected interlocutors. This revised approach provides the clues needed to illuminate experiences, beliefs, and values that were part of the ‘garbage’s social world’ but were initially left out of our research. These clues showed that the waste-pickers’ world was much more complex and diverse than the homogeneous view depicted in the initial idea of a ‘garbage-men-world’. 

This social world that we uncovered as revolving around the dumpsite was marked by much more precarity than the initial ethnography showed, because it lay at the intersection of many experiences of oppression: there were factors of gender, age, ethnicity/race, and migratory status that I was initially unable to recognise by considering social class as a primary indicator of inequalities. To sum up, ethical responsibilities include the need to consider carefully the questions Brabeck and Brabeck (2009, 40) posit so clearly: ‘Whose voices are left out of the research? What populations are ignored in the study of the phenomenon under investigation? Which experiences are not given scholarly attention?’

Minefields of hidden suffering

As already mentioned, the original research study aimed to understand how cancer control and care disparities were generated and expressed locally. However, the study was flexible enough, where needed, not to push forward the topic of cancer and instead also remain open to other, unstructured avenues of inquiry. Some of these women waste-pickers, initially contacted in 2016 during ethnographic fieldwork, were followed up using a life-course approach and we formed close bonds over the years that followed, as analysed in depth elsewhere (Luxardo and Bennet 2022).

Only when conditions of trust were established did I ask these women more focused questions about cancer control and care, especially about the rate of non-attendance and drop out from Pap smear testing[1]: that is, the interruption of gynaecological preventive practices without any further explanation. This situation was very common among the female waste-pickers, and these questions were usually answered with a smile that suggested ‘just because’, and a change of topic. I tried to carefully go deeper into these aversions, with the core principle of ‘do no harm’ in mind, recognising that many of the women participating in the study had experienced multiple traumatic events since their childhood.

These women’s stories were marked by different conditions of deprivation. But the dropout rate for Pap smears didn’t seem problematic to them. Why, I asked them, if they knew and recommended that their daughters have a Pap smear as an important healthcare practice for cancer prevention, did they not do it for themselves, despite using some other services for cancer prevention and detection, such as mammograms?

Drawing upon feminist stances of women and their experiences of moral significance (Brabeck and Brabeck 2009), in my interactions with these women I respected their priorities and their decision not to engage with preventive screening. Pregnancies were the most important issue of any conversation we had, and the women made recurrent recollections of stillborn sons and daughters, unpredictable miscarriages, and pre-term births; I realised that almost everyone in the community had suffered a direct loss. It was only after many years of close contact with these women that they began to associate these painful past situations at public health services with their experiences of cancer screening—in both situations, as women at the bottom of the social strata, treated by middle-class gynaecologists and allied health professionals. 

These experiences were the most painful of all the accounts these women shared with me. Gynaecological and obstetric services provided by the Argentinian public health system, about which I had been asking and insisting on during all these years, were identified by the women as being responsible for many of their miscarriages, and therefore seen as a threat. To make matters worse, I realised I had been recording my field notes in a diary with a big picture on the front cover of a woman with a green handkerchief (the Argentinian symbol of the fight for the right to abort, which was finally approved in December 2020), among a social group of women that was against abortion, although they did not explicitly state this until I asked. Only by the end of the fieldwork did I realise this rejection of abortion had a rationale based on an underlying kind of eugenic fear (Luxardo and Bennet 2022).

In ethics, there is an approach to researching with the vulnerable called the ‘layer’—in contrast to the ‘label’—that proposes to identify the content in terms of layers of vulnerability present in research and to prioritise them, addressing what is at risk of being harmed, mistreated, or exploited (Luna 2019). This approach should assess harms, wrongs, and risks involved in research, starting with the most harmful layers and moving down to the less damaging ones. However, unlike discrete hierarchies of layers, when researching and working with those who are vulnerable, the most harmful layer is often the last detected—the most hidden and protected, with ‘strong walls’. During fieldwork I realised that marks of vulnerabilities are, in fact, occurring simultaneously. There is nothing such as a discrete layer—from the hard or superficial outside to the deep and delicate inside. On the contrary, acute suffering can be ‘activated’ or triggered by a seemingly naïve question about football game results, a Christmas traditional recipe, or a childhood anecdote. Any of these questions can suddenly provoke unpredicted harm or discomfort. Rather than being triggered by single episodes, vulnerabilities are embedded and intertwined within long-term cumulative harmful effects and evolving meanings, linked to multiple events that occur in those scenarios. They are crossed by multiple and historical forms of restrictions and oppressions, resisted but also embodied in multiple and not self-evident ways that include increasing ill health conditions, as Manderson and Warren (2016) addressed through their ‘recursive cascades’ concept. 

Making a long-term commitment to working together, prioritising community concerns, and creating genuine bonds of trust—a process that is still ongoing with new projects that are underway—are not only methodological but ethical requisites when researching ‘the vulnerable’. Liamputtong (2008) drew attention to the emotional impact that working with vulnerable subjects has, noting how immersion in the research field and direct and prolonged contact with the participants are crucial for developing trust.

Scheper-Hughes (1995) called researchers towards a ‘barefoot anthropology’. To this I would add a call for an ethnography ‘on tip toes’, because when entering into these social worlds, like minefields, you never know where the pain is hidden. The principle of respecting privacy needs to provide conditions under which the researcher’s questions are welcome or not, and the opportunity to decline to participate. As Tom Beauchamp and James Childress (2001) explain, rights of privacy are valid claims against unauthorised access, based on the right to authorise or decline access. Ethnography often means sharing personal or private experiences and intimate events over a long period of time and this must be developed in a context of trust, as insisted on by feminist approaches to ethics, including a view to care (Edwards and Mauthner 2005). 

Stereotyping subjects through images 

From the beginning of this research project, audiovisual methods were included, complementing ethnography and other methods used in order to understand the dynamics of the waste-pickers’ daily activities, tacit codes, and settings. After a couple of years, with deepening bonds of trust among researchers and community, a consensus was reached among the parties involved to make a more formal audiovisual output: a documentary film of the research process.

This first draft of the documentary did not seek to portray a falsely romantic view of how the waste-pickers lived. However, external researchers—including myself—detected a danger of reinforcing the strong, pre-existing stigmas and stereotypes about the dumpsite and people living there because the draft only seemed to show miseries. As Kolvenbach and Fernández Bouzo (2021) assert, documentaries entail a risk of reproducing and reinforcing stereotypes about the people included in them. In this case, that risk extended to the segregated areas surrounding the dumpsite.

When we ran meetings and workshops with the community in order to define what should be removed from the documentary prior to its public distribution, most waste-pickers were against any scene removal. They said it was normal, telling me: ‘We are used to this. They [journalists, documentary makers, film students] always come to film us.’ This I could confirm, having later watched a CNN report (Bustamante 2019) on this site and a BBC report (Latourrette 2022) on a nearby garbage dumpsite, also in the province of the study (Entre Ríos). Thus, people insisted on leaving in all images, including their kids scavenging, because of their importance in provoking reactions among the broader audience and society, and perhaps, leading to political action.

Even having obtained individual and collective consent, and having checked the images that the participants had approved, the team of researchers remained preoccupied by the risk of essentialising differences and perpetuating prejudices about the waste-pickers. As researchers, we tried to anticipate all the channels through which the film would be disseminated. This ethical dilemma led to a feeling that we shouldn’t continue with the documentary in the way we were doing. In local assemblies during 2019, we discussed with the community what it would mean to be depicted in the documentary, with close-up images of what the waste-pickers do on a daily basis showing their faces. But, as mentioned, excluding such images wasn’t an option, because of the strong demand expressed to be seen and heard. This was a way of becoming visible, and our own responsibility to ‘witness’ the infringement of basic rights also had to be considered. So, we sought ways to provide the content of what these images represent, protecting them from bad uses and misrepresentation, and strengthening them to show the whole picture, which included the waste-pickers’ daily resistances, expectations, dreams, social networks, and so on.

First, we removed children’s faces, and in general avoided portraying anyone too closely during the confronting images such as when scavenging in the middle of storms and in cold conditions. During this collaborative cycle, some waste-pickers had joined the research team, after two years of knowing the original team members and the research purposes, and some of them shared in the documentary their life-stories and what it meant making a living out of a dumpsite. The ongoing consent process implicated in the research enabled us to re-check participants’ willingness to be part of the documentary. In practice, some of these life-stories which were told in front of the camera were withdrawn after some months of people reflecting on what they had said and how this portrayal could affect them. This consent reversal would not have been possible without bonds that had been created and sustained over time between and among all parties—researchers, communities, documentary makers, and local organisations—which provide a broad and long-term dynamic for the making of final decisions in research. 

Second, we avoided defining waste-pickers as ‘poor victims’. The collaborative cycle provided the basis for thinking of ways to counterbalance any stereotyping. Influenced by the long tradition of participative action research in South America, we decided to proceed through collective organisation. By taking small steps to restore symbolic and material needs (including defence of dignity), we defined precise routes of participation, aiming to provide these communities with some more resources to challenge prejudicial findings and stereotypes. These participation routes included, among others, their participation as co-authors in the book manuscript that would be eventually written by the whole research team, and their involvement in newer projects such as a vegetable garden that provided meals during COVID-19 pandemic.

Third, for 24 months (until March 2021) we went back and forth with revisions of the images, ideas, and messages featured in the documentary film through discussions in which we checked in with members, until all the voices and perspectives were heard and we had reached a consensus. Finally, we arranged that, where possible, we would keep track of the film’s dissemination routes, avoiding just simply putting it up on YouTube; and instead ensuring that it was always presented to its audiences within a clear framework and context—of the people, theories, and research depicted in the film. This contextualisation was done in seminars, conferences, local schools and institutions, among others. 

To sum up, one key ethical principle for the documentary was justice, as embodied in the shared values of action research. Under this umbrella, the fight to avoid stigmatisation and rigid categories was central, considering the ways to safeguard or empower the waste-pickers. This included thinking together about traditional ethical rules, such as confidentiality. Svalastog and Eriksson (2010) note that for some communities, anonymity takes away their control over information and how it is to be revealed, and places the researcher in a position of power. In this community, not being recognised was harmful, and some asked for identification. Thus, after careful deliberation with the community about how they could be identified without exposing the rest of the group, we decided on a range of confidentiality and anonymity measures, providing the possibility of more autonomous options of deciding how to define participation. After rechecking informed consent, some participants were included as collaborators, which allowed them to have their voice clearly stated in interviews for the documentary and for the chapters in a book.[2] 

Open-ended conclusions 

Ethical issues are an essential part of research and need to be considered throughout the process and in its aftermath, especially when structurally vulnerable groups are included. An important role is played by procedure ethics (e.g., ethical codes), but it is not sufficient; Cecchini (2019, 7) highlights the contextualised and situated character of ethics: ‘making decisions about what is appropriate in a specific situation in a specific context, and we need to pay attention to not only procedural ethics, but also to situated and applied ethics’. 

Scholars call for an ongoing critical reflection on the specific and unanticipated dilemmas that emerge during ethically important (Guillemin and Gillam 2004) or delicate moments (Cecchini 2019), which require acute sensitivity to identify. Considering ethics in concrete situations infuses reflexivity into the whole research practice, and situates scholars in terms of their own gender, class, sexuality, ethnicity/race, and generation. That is, thinking about ethics means paying careful attention to how these multiple social locations (gender, class, etc.) and pre-existing social contexts affect relationships between researchers and subjects, especially in terms of power differentials that might be imposing a tacit coercion on interlocutors, for instance.

Also relevant is an ethics of responsibility and care, which implies being ethically sensitive to what is not explicitly said but is expressed in subtle ways, and a need to consider not only individual but also collective consent as necessary, and to detect the hierarchies that exist by focusing on power dynamics and asymmetries in relationships. Finally, in my case as a researcher and also a social worker, being reflexive about ethics forced me to be much clearer about the implications of my status as both researcher and practitioner—even additionally, as a social movement militant—and the contradictions that can arise among these roles (see Kaunda-Khangamwa 2020; Augusto and Hilário 2019). 

The anthropological tradition of robust reflexivity urges attention towards context and particularities and alerts us to the necessity of thinking about how to deal with uncertainty and contradictions, rather than searching for an abstract ‘all-in-one’ set of rules to carry out research. But more than just considering ethical issues within the context of our own work within moral solipsism, decisions in applied ethics need to be integrated into broader models which offer connected rationales to address the infinite situations that can emerge, considering that principles do not stand alone. For example, models of ethics such as anti-racist, feminist, communitarian, and transformative approaches, among others, all revise historical and structural forms of oppression and discrimination, seek to access silenced points of view, consider power asymmetries, provide chances for collective decision making, and promote social justice, equity, and democracy (Thomas 2009).

These models are, explicitly or otherwise, also in convergence with specific anthropological perspectives and are part of long debates in the discipline. Scheper-Hughes’ argument for the primacy of ethics, and for an anthropology as a small practice of human liberation (Scheper-Hughes 1995, 415) calls for a responsive, reflexive, and morally or politically committed person, someone to be counted on and that ‘takes sides’ when necessary. An anthropology that is ‘ethically grounded’, then—intertwined with a political agenda, and creates an engaged process of witnessing—is one that, at the least, does not exacerbate injustices.

About the author

Natalia Luxardo is a social worker, an independent researcher at the National Scientific and Technical Research Council (CONICET), and Professor of Methodology in the Social Sciences Faculty at the University of Buenos Aires. Her expertise expands across collaborative projects on critical medical anthropology and action research with vulnerable communities. For the last two decades, she has been working on cancer disparities and day-to-day access to healthcare services and is currently working to identify the challenges for first-level cancer care and prevention among communities of fishermen, farmers and those working in garbage dumps.

Footnotes

1. A procedure in which a small brush is used to gently remove cells from the surface of the cervix and the area around it so they can be checked under a microscope for cervical cancer or cell changes that may lead to cervical cancer. Source: National Cancer Institute.↩︎

2. For more details about this documentary, see Kolvenbach and Fernández Bouzo (2021).↩︎

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