Saturday, April 03, 2010

Getting the ethical ideals right in international health research

The free, open access Editor's Choice at the Journal of Medical Ethics this month is "Responsibilities in international research: a new look revisited" by Solomon Benatar and Peter A. Singer. Back a decade ago, Benatar and Singer advocated for vision of international research ethics less focused on risks and benefits for individual research participants. They wanted to see more attention directed towards the 'big picture' issues, i.e. the background of global (social, political, economic, gender) inequalities in which international health is embedded, and which gives rise to most of the ethical problems in any particular study. Looking back, Benatar and Singer see that some of the ideas they alluded to (such as ancilliary care obligations of researchers, community engagement in research and strategic partnerships among stakeholders) have been taken up in mainstream theoretical discussions about the ethics of global health research, and, to a much more limited extent, put into practice in the field. Meeting ideals of conducting 'responsible health research' in a global context, they suggest, still has a very long way to go.

To stimulate further ethical progress, Benatar and Singer offer some (fairly obvious) ethical principles, and suggest (less obviously) that these principles are based on the ethical value of solidarity. Benatar and Singer write that, first, research undertaken in poor countries should contribute to improved health care in the community in which the research is undertaken. Second, research should enable, or empower, host country researchers to solve their own research problems in the future. Behind these principles stands solidarity, a value they see expressed in:

[A]ttitudes and determination to work for the common good across the globe in an era when interdependence is greater than ever and in which progress should be defined as enhancing capabilities and social justice rather than sustaining dependency.

It is refreshing to see this attempt to put solidarity back into currency among those involved in bioethics. On the other hand, it is somewhat sad to be reminded, in 2010, of ethical principles that should not even require a reminder, and to become conscious of the relative disuse into which the notion of solidarity has fallen. But maybe getting the ideals right is the first step to getting the practices right.

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