Justice in Research

Recently Transportation Secretary Sean P. Duffy announced the design of a female crash test dummy to be used in tests of car safety (see Trump’s Transportation Secretary Sean P. Duffy Unveils Design for First-of-its-Kind Advanced Female Crash Test Dummy | US Department of Transportation). As reported by news outlets, this is a change that has been a long time coming (see The long, slow road to developing a female crash test dummy : NPR for one example). As described by Consumer Reports, researchers have known since the early 1980’s that men’s and women’s bodies respond differently to car crashes (see A Crash Test Bias Puts Female Drivers at Risk - Consumer Reports). For example, a 2013 NHSTA study of data from the Fatality Analysis Reporting System (FARS) found that front-row female occupants were 17% more likely to be killed than front-row male occupants in crashes of passenger vehicles manufactured from 1960-2011. Noting that this sample contained cars with less sophisticated safety measures, the analyses were reconducted in 2019 with subgroups, allowing for consideration of vehicles with more modern safety measures. Even with newer cars included in the sample, NHSTA found women were still more likely to be killed than men, though this risk was less with newer cars (see Female Crash Fatality Risk Relative to Males for Similar Physical Impacts for more information). This bias in the research on car crashes means that half the population is at greater risk of dying in a car crash.

As described by the Belmont report (see The Belmont Report), justice should be a key consideration when considering the ethics of research that impacts humans, and when recruiting humans for studies. Justice in this case means there is an equitable distribution of research burdens and benefits. Though no humans are used in crash tests, the exclusion of women crash test dummies seems unethical because there is unequal distribution in the benefits of the research society wide. When designing research studies, one must consider how to ensure fairness in research participation and benefits.

Justice became a key principle of ethics in human subjects’ protections due to experiments where marginalized groups bore the burdens of being test subjects, while the benefits of the research flowed to the more privileged. One infamous example from the U.S. was the U.S. Public Health Service Untreated Syphilis Study which was conducted for 40 years in Tuskegee and Macon Counties in Alabama between 1932 and 1972. African American men with syphilis in these rural counties were recruited to participate in the study, without proper informed consent, and with promises of treatment they were never given (see About The Untreated Syphilis Study at Tuskegee | Syphilis Study | CDC for more information, including an informative video).

The Belmont Report provides some recommendations for consideration to ensure justice is addressed in your research. Obviously, some key points are avoiding the exploitation of vulnerable populations, having fair study inclusion and exclusion criteria, and ensuring the benefits of the research are equitably distributed. In addition to these points, the report also notes that researchers may need to check institutionalized biases that can lead to injustice, even if research subjects are treated fairly. As stated in the Belmont Report:

“Injustice may appear in the selection of subjects, even if individual subjects are selected fairly by investigators and treated fairly in the course of the research. This injustice arises from social, racial, sexual and cultural biases institutionalized in society. Thus, even if individual researchers are treating their research subjects fairly, and even if IRBs are taking care to assure that subjects are selected fairly within a particular institution, unjust social patterns may nevertheless appear in the overall distribution of the burdens and benefits of research. Although individual institutions or investigators may not be able to resolve a problem that is pervasive in their social setting, they can consider distributive justice in selecting research subjects.”

An example of these biases is the long-standing assumption that women’s bodies are basically the same as men’s bodies, except for the reproductive organs and size, with the male body being the default (see Invisible Women (2019) by Caroline Criado Perez for a great discussion of this). This assumption has led to a well-documented history of women being excluded from clinical trials – and from being represented as crash-test dummies for car testing.

Researchers must question their own biases to ensure they don’t inadvertently commit injustice in their research. Some additional questions researchers can consider ensuring justice is addressed in their research designs are:

1. Participant Selection

• Are inclusion and exclusion criteria fair and scientifically justified?

• Could any group be unfairly burdened or excluded without reason?

• Are vulnerable populations involved only when necessary and with added protections?

2. Distribution of Risks and Benefits

• Are research risks equitably distributed across participant groups?

• Will benefits (e.g., access to interventions, knowledge) reach all groups fairly?

• Is there a plan for post-study access to successful interventions?

3. Recruitment Practices

• Are recruitment strategies inclusive and culturally sensitive?

• Does the process avoid exploiting economically or socially disadvantaged groups?

• Are incentives appropriate and non-coercive?

4. Representation and Equity

• Does the study design address underrepresentation of minority or marginalized populations?

• Are efforts made to include diverse participants where relevant?

5. Global and Community Considerations

• For international research, are local communities consulted and respected?

• Are benefits shared with host communities, not just sponsors?

6. Oversight and Accountability

• Has the IRB or ethics committee reviewed justice-related concerns?

• Is there transparency in how decisions about participant selection and benefit sharing are made?