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DOI

International clinical research and the problem of benefiting from injustice

01 Jan 2014-pp 169-184

AbstractClinical trials are increasingly “offshored” to developing countries. Many participants in these trials can plausibly be regarded as victims of deep structural injustices, e.g. severe avoidable pov ...

Topics: Injustice (53%)

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Journal Article
Abstract: Contrasting his own position with that of those who conceive the moral challenge of global poverty in terms of a positive duty to help, Thomas Pogge suggests that “we may be failing to fulfill our stringent negative duty not to uphold injustice, not to contribute to or profit from [emphasis added] the unjust impoverishment of others” (p. 197). We should conceive of our individual donations and of possible institutionalized initiatives to eradicate poverty not as helping the poor but “as protecting them from the effects of global rules whose injustice benefits us and is our responsibility” (p. 23, emphasis added). Pogge also claims that such activities should be understood in terms of compensation: “The word ‘compensate’ is meant to indicate that how much one should be willing to contribute toward reforming unjust institutions and toward mitigating the harms they cause depends on how much one is contributing to, and benefiting from, their maintenance” (p. 50, emphasis added). In characterizing wrongful involvement in an unjust social order and the compensatory duties that arise from it, Pogge refers to the terms contribution/responsibility as well as to benefit/profit (the latter are used interchangeably). The first of these factors is unobjectionable: we can take it for granted that there is a negative duty not to contribute to injustice and that those who are responsible for harmful institutions should compensate their victims. I want to raise doubts, however, about the role that Pogge assigns to benefiting from injustice in the determination of our duties toward the victims of injustice. I shall do so by challenging his claim that there is a negative duty not to benefit from injustice, and that the role that benefiting from injustice plays in determining our duties to work toward reforming unjust practices and mitigating their harmful effects is best understood in terms of compensation.

5 citations


Journal ArticleDOI
Abstract: Recent years have seen a growing philosophical interest in the concept of exploitation as well as in putatively exploitative practices, such as commercial surrogacy, sweatshop labor, and medical research in the developing world. This article contributes to the philosophical debate in this area by focusing on a problem about exploitation that has remained largely unexamined until now. The debate has concentrated on the kind of situation where one party to a transaction or relationship, A, exploits another party, B, and A benefits himself/herself. At the same time, philosophers have for the most part ignored cases where A exploits B, but the gains A extracts from B accrue not (only) to A but (also) to a third party, C . This omission is striking because such cases are easily found in the real world. Clinical researchers and their sponsors may exploit research subjects to advance the interests of future patients. Sweatshops may exploit workers in poor countries on behalf of multinational firms and for the benefit of their customers. In fact, it is plausible to claim that, more often than not, several parties stand to gain from putatively exploitative practices in today’s globalized economy. For example, Iris Marion Young (2011, ch. 5) paints a vivid picture of the complex and multilayered network of actors (i.e., sweatshops, multinationals, intermediaries, distributors, retail and wholesale companies, individual and group customers, and so on) who make up one prominent such practice, the global apparel industry. Therefore, in order to be genuinely practically relevant, exploitation theory needs a better grasp of how third parties can be involved in exploitative transactions and arrangements and of the normative significance of such involvement. Young herself, while emphasizing that the circle of those bearing some (mostly forward-looking) responsibility in connection with such transactions and arrangements is much broader than commonly thought, does not systematically distinguish among different kinds of third-party involvement. Our work undertakes such an analysis. We distinguish between different types of cases corresponding to different kinds of involvement in exploitation by the third party. We also argue that these different types of involvement have different moral implications—especially as regards the remedial duties incurred by the third parties. Our main claim is that in many cases third-party beneficiaries can be properly construed as acting together with exploiters in bringing about and/or maintaining the exploitative relationship or transaction. Establishing joint action in such cases is important because, first,

4 citations


Cites background from "International clinical research and..."

  • ...Some hold that the essential wrong of exploitation consists in the violation of some norm of fairness (Wertheimer 1996, 2011; Mayer 2007; Valdman 2009)....

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References
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Journal ArticleDOI
24 May 2000-JAMA
TL;DR: 7 requirements are proposed that systematically elucidate a coherent framework for evaluating the ethics of clinical research studies and are universal, although they must be adapted to the health, economic, cultural, and technological conditions in which clinical research is conducted.
Abstract: Many believe that informed consent makes clinical research ethical. However, informed consent is neither necessary nor sufficient for ethical clinical research. Drawing on the basic philosophies underlying major codes, declarations, and other documents relevant to research with human subjects, we propose 7 requirements that systematically elucidate a coherent framework for evaluating the ethics of clinical research studies: (1) value-enhancements of health or knowledge must be derived from the research; (2) scientific validity-the research must be methodologically rigorous; (3) fair subject selection-scientific objectives, not vulnerability or privilege, and the potential for and distribution of risks and benefits, should determine communities selected as study sites and the inclusion criteria for individual subjects; (4) favorable risk-benefit ratio-within the context of standard clinical practice and the research protocol, risks must be minimized, potential benefits enhanced, and the potential benefits to individuals and knowledge gained for society must outweigh the risks; (5) independent review-unaffiliated individuals must review the research and approve, amend, or terminate it; (6) informed consent-individuals should be informed about the research and provide their voluntary consent; and (7) respect for enrolled subjects-subjects should have their privacy protected, the opportunity to withdraw, and their well-being monitored. Fulfilling all 7 requirements is necessary and sufficient to make clinical research ethical. These requirements are universal, although they must be adapted to the health, economic, cultural, and technological conditions in which clinical research is conducted. JAMA. 2000;283:2701-2711.

1,978 citations


Book
01 Jan 2015
Abstract: Foreword: Bill and Melinda Gates Preface: Peter Singer Acknowledgments Famine, Affluence, and Morality The Singer Solution to World Poverty What Should a Billionaire Give - and What Should You? Index

1,605 citations


"International clinical research and..." refers background in this paper

  • ...And proponents of an individual duty to aid stress how easy it is for relatively affluent individuals to bring great relief through modest financial donations (capacity) (Singer 1972)....

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  • ...Or it may be that Sam has a general humanitarian duty to assist the desperately needy, wherever they are, if he can do so at little personal cost (Singer 1972)....

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Book
Thomas Pogge1
01 Jan 2002
Abstract: Despite a high and growing global average income, billions of human beings are still condemned to life long severe poverty, with all its attendant evils of low life expectancy, social exclusion, ill health, illiteracy, dependency, and effective enslavement. The annual death toll from poverty-related causes is around 18 million, or one-third of all human deaths, which adds up to approximately 270 million deaths since the end of the Cold War.

1,530 citations


"International clinical research and..." refers background in this paper

  • ...For instance, those inclined to hold foreign states responsible often appeal to the role of these states in creating these problems in the first place (moral or causal responsibility) (Pogge 2008)....

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  • ...7 For compelling arguments to this effect, see Pogge (2008)....

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  • ...Others believe that it lies, in large part at least, with the governments of affluent countries, or with international bodies such as the World Health Organization (WHO) and the World Trade Organization (WTO) (Pogge 2008)....

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01 Jan 2001
TL;DR: Adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, and amended by the 29th WMAs, Tokyo, Japan, October 1975, and the 52nd WMAGeneral Assembly, Edinburgh, Scotland, October 2000.
Abstract: Adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964; amended by the 29th WMA General Assembly, Tokyo, Japan, October 1975; 35th WMA General Assembly, Venice, Italy, October 1983; 41st WMA General Assembly, Hong Kong, September 1989; 48th WMA General Assembly, Somerset West, Republic of South Africa, October 1996, and the 52nd WMA General Assembly, Edinburgh, Scotland, October 2000.

1,243 citations


Journal ArticleDOI
TL;DR: This work applies a previously proposed ethical framework for clinical research within developed countries to developing countries explicating a previously implicit requirement for collaboration and proposes specific and practical benchmarks to guide researchers and research-ethics committees in assessing how well the enumerated ethical principles have been fulfilled in particular cases.
Abstract: In recent years there has been substantial debate about the ethics of research in developing countries. In general the controversies have centered on 3 issues: first the standard of care that should be used in research in developing countries; second the “reasonable availability” of interventions that are proven to be useful during the course of research trials; and third the quality of informed consent. The persistence of controversies on such issues reflects in part the fact that existing ethical guidelines can be interpreted in multiple ways are sometimes contradictory or rely on unstated yet controversial ethical principles. To provide unified and consistent ethical guidance we apply a previously proposed ethical framework for clinical research within developed countries to developing countries explicating a previously implicit requirement for collaboration. More importantly we propose specific and practical benchmarks to guide researchers and research-ethics committees in assessing how well the enumerated ethical principles have been fulfilled in particular cases. (excerpt)

794 citations