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A blog about the Suicide Cultures research project

Category: Ethics

Working through the ethics of ‘Suicide Cultures’: Part II – The ethics of anonymization

In this post we continue with a discussion of some of the ethical challenges we are encountering as part of the Suicide Cultures project. Here we will focus specifically on the ethical challenges of working with the Fatal Accident and Sudden Deaths Inquiries (FAIs) of people who have died by suicide in prison. This post is intended as an explicit and transparent reflection on the complexities of issues of anonymization and an ongoing thinking project about issues of care, privacy and critiques of institutional framings of suicide. The reflections we present here have been born out of many discussions within the Suicide Cultures research team, as well as consultation with Sarah Armstrong, Linda Allan and Betsy Barkas, who are also working with FAIs.

As part of the Suicide Cultures project we are conducting an analysis of all the FAIs of deaths in prison due to suicide in Scotland from 2016 until the present. Prisons have been identified as having high rates of suicide (Tomczak, 2018; Zhong et al., 2021). Scottish prisons record higher rates than those in England and Wales, although there are a number of issues which make comparisons problematic (Armstrong & McGhee, 2019). Given that prisons are significant sites of suicide, it is important to explore how suicide is understood and responded to within these contexts. Our analysis focuses on how suicide is constructed within FAIs and the implications of these constructions for understanding the role of the prison environment in deaths by suicide.

When we say ‘how suicide is constructed’, we mean that the ways in which suicide is talked about and portrayed creates particular social ‘truths’ about suicide. These include ‘truths’ about what causes suicide and how it should be responded to. These ‘truths’ come to be taken for granted and regarded as the only explanation for suicide. For example, one of the dominant ways in which suicide is often constructed in research, as well as public policy, is as an individual mental health problem (see Marsh, 2020). This is done through explaining suicide as being caused by mental illness such as depression and proposing that the best way to prevent suicide is through individual therapeutic and pharmacological interventions. These constructions tend to focus solely on the ‘suicidal’ individual, neglecting the broader context in which the individual lives. In contrast, research which focuses on the social contexts in which people live highlights “the heart-rendering suffering, daily indignities, and desolation many people struggle with” (Reynolds, 2016, p.169), including poverty, homophobia, racism and other forms of social exclusion and violence (White, 2017). This kind of work constructs suicide as an issue of social justice rather than an individual mental health issue and proposes that suicide can only be ‘prevented’ by making lives more liveable for all people. It is important to note that these social constructions of suicide are not static and that they change and shift over time[1]. In our analysis we are interested in the kinds of truths about suicide that are presented in the FAIs.

An FAI is an inquiry, conducted by a sheriff, the purpose of which is to “(a) establish the circumstances of the death, and (b) consider what steps (if any) might be taken to prevent other deaths in similar circumstances”. An FAI is carried out for certain kinds of deaths, including when the death occurs while a person is in legal custody. As one sheriff noted in their report “The primary purpose of a fatal accident inquiry (‘FAI’) is to give a public airing of the facts surrounding a death or fatal accident. This affords those with a direct interest, such as the family of the deceased, the chance to hear first-hand from witnesses and learn the full circumstances of the death as they are known”.

These reports are publicly available, to facilitate transparency and public accountability, and include full names and many other personal details of the person who has died, and in some instances of their family, partners and friends. In light of the public nature of these reports, the issue of anonymization to protect people’s privacy is complicated. Normally in qualitative research, we pseudonymise participants – changing people’s names, and sometimes key details, in order to protect their privacy. This allows people to participate in a research project without necessarily exposing personal details about themselves. However, as Betsy Barkas noted in our discussion about working with FAIs, people’s anonymity has already been violated by the state in the case of FAIs, making it difficult for researchers to preserve people’s privacy.

As a research team we have found ourselves asking: how we can present a critical analysis of the FAIs, which explores the often-problematic ways in which people who have died by suicide are constructed, while preserving, as far as possible, the dignity of those who have died, as well as their loved ones who have been affected by their deaths?

We feel that a critical analysis, which draws directly on quotes from the FAIs, is important to be able to both highlight and disrupt the decontextualized ways in which prison suicides are understood, as well as the ways in which the systems and environment of the prison are implicated in people’s deaths. We have all been deeply moved, distressed and angered by what we have read in the FAIs and we hope to be able to draw on some of these feelings in our writing, to communicate in more affective ways about the people who have died by suicide in prison.  We recognise that each person who has died by suicide is a human being, deserving of dignity and respect, whose life cannot and should not be reduced to the details of their deaths as recounted in the FAI.  We aim to make this point clear in our writing about the FAIs, as well as, as far as possible, not to reproduce harmful constructions of those who have died. We hope that through presenting a critical analysis of the institutional frameworks through which suicide is presented, we can challenge dehumanising representations of people who have died by suicide.

We also recognise that our analysis of the FAIs, which includes potentially recognisable information about the person who has died, may be distressing for their loved ones. We have, therefore, decided not to use people’s real names. We will be using pseudonyms for all participants, as well as removing or altering demographic information in order to reduce, as far as possible, identifying information. However, as we have highlighted above, the publicly available nature of the FAIs mean we cannot guarantee that people will not be identifiable.

It was mentioned in our discussion with Linda Allan, Betsy Barkas and Sarah Armstrong that some families may want their loved ones explicitly named, as this may be an important way of honouring them and the conditions under which they died. It is possible that some of the families of the people represented in the FAIs we are analysing may feel similarly. However, after long deliberation we have decided not to reach out to families. The FAI process is, more often than not, very drawn out and so many of the deaths we will be analysing occurred many years ago. We recognise that some families may find it intrusive to be contacted by researchers after so many years and that they may not wish to revisit the death of their loved one in this way. This is in line with our original ethics application, where we proposed that we would not contact the families. After having seen the reviews, it has also become clear that in many instances the families are not named and therefore finding and contacting them would itself be intrusive and something we feel is ethically questionable.

There are no easy ethical answers when it comes to doing research on suicide, which becomes even more complicated when working with publicly available data collected by the state. The institutional environment of the prison removes certain rights from prisoners, while the FAIs construct their lives backwards through their final act of suicide. In our work we want to take care to avoid creating further suffering for the families of those who have died by treating the subjects of FAIs as whole human beings caught within complex institutional, legal, social, and economic forms of oppression.  We hope that by more explicitly articulating our own ethical position, we make ourselves more ethically accountable as we continue this difficult work.

References:

Armstrong, S., & McGhee, J. (2019). Mental health and wellbeing of young people in custody: Evidence review. The Scottish Centre for Crime & Justice Research. https://www.sccjr.ac.uk/publication/mental-health-and-wellbeing-of-young-people-in-custody-evidence-review/

Marsh, I. (2020). Suicide and social justice: Discourse, politics and experience. In M. E. Button & I. Marsh (Eds.), Suicide and social justice: New perspectives of the politics of suicide and suicide prevention. Routledge.

Reynolds, V. (2016). Hate kills: A social justice response to “suicide”. In J. White, I. Marsh, M. Kral, &. J. Morris (Eds.), Critical suicidology: Towards creative alternatives. University of British Columbia Press.

Tomczak, P. (2018). Prison suicide: What happens afterward? Bristol, Bristol University Press.

White J. (2017). What can critical suicidology do? Death Studies, 41(8), 472–480. https://doi.org/10.1080/07481187.2017.1332901

Zhong, S., Senior, M., Yu, R., Perry, A., Hawton, K., Shaw, J., and Fazel, S. (2021). Risk factors for suicide in prisons: a systematic review and meta-analysis. Lancet Public Health, 2020(6), e164-74.

[1] For example, in many contexts suicide was historically regarded as a criminal act. In contemporary societies this ‘truth’ has been replaced by the ‘truth’ that suicide is caused by mental illness.

Prison cell” by decade_null is licensed under CC BY 2.0.

Working through the ethics of ‘Suicide Cultures’: Part I – In Good Faith

This post is the first in a new series on the Suicide Cultures blog, exploring the ethics of the project. We will periodically post new pieces discussing ethical challenges we encounter, discussions we have, and actions we take to try to find solutions.

The idea of moving discussions of complex ethical issues into actions came up during our most recent Suicide Cultures seminar, led by Fiona Malpass and Jennifer White. That presentation invited participants to discuss the Critical Suicide Studies ethics statement, and at the end, the facilitators asked us to think about what actions we would take as a result of the rich and challenging discussion during the session. [Keep an eye out for the recording/summary coming to the Seminar Series section of this blog soon.] To respect the privacy of participants, we will not discuss the details of the seminar in depth here – though many of the issues raised are similar to those raised within the Suicide Cultures team, which we will discuss throughout this ethics blog series.

The ethics application: Ethics 101

For all researchers working with people, an institutional ethics application is one of the fundamental actions we must take. In this first ethics blog post, we review some of the ethical challenges the Suicide Cultures team faces – discussing both the process of putting together our actual ethics application as well as some of the ‘less tangible’ ethical conundrums with which we struggle. We used the process of writing the ethics application as a starting point in moving our theoretical ethical questioning into the realm of the practical, as we prepare for fieldwork to commence this year. The process of engaging in what can feel like a bureaucratic ‘box-ticking’ exercise can be an action that jump-starts more complexity in thinking about ethics than the form may allow – if we engage with ethics as an on-going process, in good faith. For further reading, and a recent example of deep reflection on, challenging of, and expansion of thinking around the ethical considerations of suicide research, see Jaworski (2022).

There are plenty of scathing indictments of institutional ethics procedures, and for good reason. We will touch on some of these negatives but want to focus on the positives that can arise from engaging with institutional ethics – and the ways in which researchers can help their institutions evolve by putting more, and more in-depth thought, into their ethics applications. Here are some of the ways in which we tried to push the bounds of our ethics application.

One of the challenges can be when bureaucracy seeks to ‘protect’ ‘vulnerable’ participants in ways which provide legal cover but little real support. This tension can present in many ways, for example in researchers jumping through hoops to provide standardised procedures and token protections that do not allow for the development of individualised safety plans for participants. For the Suicide Cultures project, we contended with this challenge by creating a standard format for developing safety plans with participants, with some general resources populated, but also leaving space for one-to-one discussions of support needs with participants. By including this in our ethics application, we hope to build upon the idea of what protection means – and introduce agency and self-determination into the development of safety plans. This issue can also manifest in a tension between agency and protection – for example, we as researchers may be required to inform authorities if we believe a participant is intending to harm themselves in the immediate future. We stated this requirement clearly on our participant information sheets, in order to be up front with the constraints on researchers as professionals, which in turn can constrain participants’ agency. We hope this will enable participants to choose what they share with us carefully.

We are also working with a range of creative methodologies – which come with their own challenges, not least of which is the additional scrutiny applied to non-traditional methods. Part of ensuring we can justify the use and value of these methods involved exploring the lessons learned from those already using these methods; we read about photo voice, mapping, walking interviews (as well as interviewing in general and ethnography/participant observation) in-depth, discussed what we found, and explored legal and copyright rules and health-and-safety concerns. We continued this action by hosting a small internal seminar on all of these methods – to share this learning and discuss the implications of these methods – in a similar manner to the ethics seminar discussed in the introduction. These are small, early-stage actions that can help us to engage in research in as ethical a way as we can – and to continue the conversations beyond the forms.

Continuously engaging with ethics is important, because one of the major challenges we faced in trying to translate some of our ethical concerns into concrete actions for the research project was doing this with all of the uncertainties that accompany research planning. Realistically, we cannot predict every challenging situation that will arise across the lifetime of the project – especially since at the moment in-person versus digital is still a major question as Covid-19 continues to disrupt our ‘usual’ ways of doing research.

Institutional ethics is important in that it compels researchers to think about accountability and protection. It can also jump start more complex thought processes around ethics; we are challenged to think ahead and to think about ALL of the people who may be involved/impacted. For example, in a previous ethics application we submitted, for a review of Fatal Accident Inquiry (FAI) reports of deaths by suicide in prison, we had to consider the impact of our document review on (for example) the families of the person who has died, witnesses in the inquiry, and the sheriff who wrote the report. We also continue to grapple with the use of reports about a person who cannot consent or contribute to the process. [We plan to dedicate a separate post in this series to the ethics of these FAI reviews, and to issues around the use of information about and creation of subjectivity around someone who has died.]

Ethics beyond the application: The struggle to do no harm – and to try to do good

During a recent Suicide Cultures team meeting, we discussed the newsletter that we send to our mailing list with updates about the project. This discussion naturally segued into a conversation about how much to reveal, how identifiable areas we work in might be from different outputs we have/will produce, and the discomfort of writing about other people. We did not come up with any ‘good’ answers, but we agreed that having these discussions was a positive sign – and that engaging with ethics in research is an ongoing process that must be undertaken to the best of our abilities. We are trying to work in good faith – knowing that there is no such thing as perfectly ‘ethical’ research. Following this discussion, we took the action of dedicating a session of our monthly meeting series on emotions to think through the discomfort that comes along with trying to do research in an ethical manner – and how we can use, engage with, and sit with that discomfort.

To conclude this introductory post in our ethics series, we made a list of some of the concerns we continue to grapple with – engaging in discussions and imagining ways to translate these discussions into actions. We will explore some of these topics in future posts in this series – for now, we leave you with only (a limited list of) questions:

  • The tension between agency and protection (revisited).
    • How do we engage communities?
    • How do we incorporate feedback into our work?
    • How do we navigate the line between agency/self-determination and qualitative analysis?
  • Moving online: ethics of research during Covid-19.
    • Ensuring safety;
    • Following rules;
    • The impact of the digital divide.
  • How do we relate to ethics ourselves?
    • In what ways are we implicated in systems (e.g. through analysis of FAI reports)?
    • To what extent do we have the right to do this research? Why do we do it (anyway)?
  • How can we keep engaging in actions to do ethical research in good faith?

 

References

Jaworski, K. (2022). The ethics of facing the Other in suicide. Health, 26(1), pp. 47-65.

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