Date of Award

11-2025

Degree Type

Thesis

Degree Name

Master of Bioethics

First Advisor

Dr. Tashfeen Ahmad

Second Advisor

Dr. Mustafa Aslam

Third Advisor

Dr. Asfiya Aziz

Department

Educational Development

Abstract

Background: Research participant compensation represents a persistent ethical challenge in balancing fair recognition of contributions against risks of undue inducement, particularly in resource-limited settings. In Pakistan and similar low- and middle-income countries (LMICs), profound economic disparities between researchers and participants intensify these tensions. Despite extensive theoretical literature on compensation ethics, limited empirical research examines how researchers themselves conceptualize fairness, navigate competing ethical principles, and make practical compensation decisions. Understanding researcher perspectives is essential for developing contextually appropriate guidance that supports ethical practice while remaining operationally feasible.
Objectives: This study aimed to explore how researchers at a private-sector academic institution in Pakistan perceive and navigate the ethical complexities of research participant compensation. Specific objectives included: (1) exploring researchers' conceptualizations of fair compensation and undue inducement; (2) examining ethical dilemmas and decision-making challenges encountered when designing compensation schemes; (3) investigating how economic vulnerability influences compensation strategies; and (4) identifying perceived best practices and guidance needs for ethical compensation that minimizes inducement risks.
Methods: A qualitative research design employing in-depth semi-structured interviews with 11 principal investigators and senior researchers at Aga Khan University, Karachi, was conducted. Participants represented diverse disciplines (pediatrics, community health sciences, medicine, cardiology, gastroenterology) and research contexts (clinical trials, cohort studies, community based research). Thematic analysis following Braun and Clarke's six-phase approach was performed. A complementary systematic document audit evaluated institutional (AKU), national (National Bioethics Committee, Drug Regulatory Authority of Pakistan), and international (CIOMS, Declaration of Helsinki, Belmont Report) guidelines against a structured framework 5 assessing compensation guidance comprehensiveness. Findings were integrated through triangulation to ensure depth and validity
Results: Seven major themes with 22 sub-themes emerged, revealing conceptual ambiguity surrounding fairness and undue inducement, decision-making without objective standards, and systematic institutional guidance deficits. Researchers acknowledged fairness as subjective and struggled to define undue inducement operationally. All researchers framed compensation as reimbursement and most endorsed burden-proportionate payment, yet lacked frameworks for systematic implementation. Economic vulnerability intensified inducement concerns, with responses ranging from payment conservatism to challenging assumptions about coercion. Researchers made decisions without objective criteria, relying on precedent, team consensus, and field staff input. Most were unaware of institutional guidelines and desired structured guidance balancing standardization with flexibility. Document analysis also confirmed this deficit and triangulation validated that documented policy gaps directly correspond to researchers' experienced challenges.
Conclusion: Participant compensation represents a critical blind spot in research ethics, particularly in LMICs where economic vulnerability heightens complexity. This study identifies a 'protection paradox' where researchers default to payment conservatism to avoid undue inducement, inadvertently risking exploitation through underpayment. Addressing this requires moving beyond abstract principles to 'structured flexibility' i.e. implementing institutional compensation grids, context-sensitive calculation frameworks, addressing systemic administrative barriers and collaborative regulatory review. These interventions are essential to transition compensation from an ad hoc administrative burden to a principled ethical obligation.

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Last Page

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