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Saleh S, Sambakunsi H, Nyirenda D, Kumwenda M, Mortimer K, Chinouya M. Participant compensation in global health research: a case study. Int Health 2021; 12:524-532. [PMID: 33165559 PMCID: PMC7651450 DOI: 10.1093/inthealth/ihaa064] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/11/2020] [Accepted: 08/25/2020] [Indexed: 01/19/2023] Open
Abstract
Background Compensation for research participants can be provided for reasons including reimbursement of costs; compensation for time lost, discomfort or inconvenience; or expression of appreciation for participation. This compensation involves numerous ethical complexities, at times entailing competing risks. In the context of transnational research, often incorporating contexts of economic inequality, power differentials and post-colonialism, these issues extend into wider questions of ethical research conduct. Methods We describe experiences of conducting a community-based study of air pollution in southern Malawi incorporating ethnographic, participatory and air quality monitoring elements. Decisions surrounding participant compensation evolved in response to changing circumstances in the field. Results Attention to careful researcher–participant relationships and responsiveness to community perspectives allowed dynamic, contextualised decision-making around participant compensation. Despite widely cited risks, including but not restricted to undue influence of monetary compensation on participation, we learned that failure to adequately recognise and compensate participants has its own risks, notably the possibility of ‘ethics dumping’. Conclusions We recommend active engagement with research participants and communities with integration of contextual insights throughout, including participant compensation, as for all elements of research conduct. Equitable research relationships encompass four central values: fairness, care, honesty and respect.
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Affiliation(s)
- Sepeedeh Saleh
- Malawi-Liverpool-Wellcome Trust, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi.,Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Henry Sambakunsi
- Malawi-Liverpool-Wellcome Trust, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
| | - Deborah Nyirenda
- Malawi-Liverpool-Wellcome Trust, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
| | - Moses Kumwenda
- Malawi-Liverpool-Wellcome Trust, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Martha Chinouya
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Kerpel-Fronius S, Baroutsou V, Becker S, Carlesi R, Collia L, Franke-Bray B, Kleist P, Kurihara C, Laranjeira LF, Matsuyama K, Naseem S, Schenk J, Silva H. Development and Use of Gene Therapy Orphan Drugs-Ethical Needs for a Broader Cooperation Between the Pharmaceutical Industry and Society. Front Med (Lausanne) 2020; 7:608249. [PMID: 33425952 PMCID: PMC7785873 DOI: 10.3389/fmed.2020.608249] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/02/2020] [Indexed: 01/28/2023] Open
Abstract
Gene therapy orphan medicinal products constitute a unique group of new drugs which in case of hereditary diseases are usually administered only once at an early age, in the hope to provide sufficient gene product to last for the entire life of the patients. The combination of an exceptionally large single payment and the life-long clinical follow-up needed for understanding the long-term benefits and safety of gene therapy, represent new types of scientific, financial, social and ethical challenges for the pharmaceutical industry, regulators and society. With special consideration of the uniqueness and importance of gene therapy, the authors propose a three points plan for a close cooperation between the pharmaceutical industry and society to develop orphan gene therapy. (1) In fully transparent health technology negotiations a close and long-lasting, contractually fixed cooperation should be established between the manufacturers and local health-care stakeholders for sharing the medical and scientific benefits, the financial risks as well as the burdens of the post-authorization clinical and regulatory development. (2) The parties should agree on a fair, locally affordable drug price without the usually very high premium price calculated to compensate for the low number of patients. In case of high manufacturing costs, the companies should offer prolonged, 15–20 years long payment by installment with risk-sharing, especially considering that the late outcome of the treatment is unknown. Society should assist scientifically and financially organizing a specific patient registry, treatment in specialized hospitals and adequate long-term follow-up of patients, the coordinated management of financial transactions related to the risk sharing program. (3) The post-authorization treatment and prolonged observation of additional new cases coordinated by society should provide real world data needed for the modern complex regulatory evaluation of gene therapy products by the competent authorities. We assume that fair sharing of the benefits and risks as well as a well-organized cooperation of society with the industry in collecting real world evidence might result in better drug evaluation and improved accessibility due to lower prices. The outlined concept might support gene therapy more efficiently than the presently requested outstandingly high prices.
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Affiliation(s)
- Sandor Kerpel-Fronius
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Varvara Baroutsou
- Independent Medical Consultant & Pharmaceutical Medicine Consultant, Athens, Greece
| | - Sander Becker
- Consultants in Pharmaceutical Medicine, Dover Heights, NSW, Australia
| | | | | | | | | | - Chieko Kurihara
- Quality Assurance and Audit Office, Quantum Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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King M, Ballantyne A. Donor-funded research: permissible, not perfect. JOURNAL OF MEDICAL ETHICS 2019; 45:36-40. [PMID: 30228163 DOI: 10.1136/medethics-2018-104966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/08/2018] [Accepted: 08/22/2018] [Indexed: 06/08/2023]
Abstract
Donor-funded research is research funded by private donors in exchange for research-related benefits, such as trial participation or access to the trial intervention. This has been pejoratively referred to as 'pay to play' research, and criticised as unethical. We outline three models of donor-funded research, and argue for their permissibility on the grounds of personal liberty, their capacity to facilitate otherwise unfunded health research and their consistency with current ethical standards for research. We defend this argument against objections that donor-funded research is wrongly exploitative, unfair and undermines the public good of medical research. Our conclusion is that, like all human subjects research, donor-funded research should be regulated via standard health research legislation/guidelines and undergo Research Ethics Committee/Institutional Review Board and scientific peer-review. We expect that, measured against these standards, some donor-funded research would be acceptable.
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Affiliation(s)
- Mike King
- Bioethics Centre, School of Medical and Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Angela Ballantyne
- Bioethics Centre, School of Medical and Surgical Sciences, University of Otago, Dunedin, New Zealand
- Department of Primary Health Care and General Practice, University of Otago, Dunedin, New Zealand
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Andanda P, Wathuta J. Human dignity as a basis for providing post-trial access to healthcare for research participants: a South African perspective. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:139-155. [PMID: 28601920 DOI: 10.1007/s11019-017-9782-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper discusses the need to focus on the dignity of human participants as a legal and ethical basis for providing post-trial access to healthcare. Debate about post-trial benefits has mostly focused on access to products or interventions proven to be effective in clinical trials. However, such access may be modelled on a broad fair benefits framework that emphasises both collateral benefits and interventional products of research, instead of prescribed post-trial access alone (Legal and ethical regulation of biomedical research in developing countries p. 134, 2016). The wording of the current version of the Declaration of Helsinki could in fact be interpreted to broaden the scope to include other collateral benefits by applying such a broad fair benefits framework. We argue that this possibility should be utilised by low and middle income countries' (LMICs) health research ethics committees (RECs) in order to ensure that research participants who enrol in clinical trials so as to receive medical care continue to access care after the trial is concluded, as befits their dignity. Although each LMIC has unique concerns, nonetheless there are common challenges based especially on emerging issues, such as post-trial access to healthcare. Accordingly, the South African perspective is used to draw lessons that can benefit other LMICs.
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Affiliation(s)
- Pamela Andanda
- School of Law, University of the Witwatersrand, Johannesburg, South Africa.
- University of the Witwatersrand, Private Bag 3, WITS, Johannesburg, 2050, South Africa.
| | - Jane Wathuta
- School of Law, University of the Witwatersrand, Johannesburg, South Africa
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Dauda B, Dierickx K. Viewing benefit sharing in global health research through the lens of Aristotelian justice. JOURNAL OF MEDICAL ETHICS 2017; 43:417-421. [PMID: 28550158 DOI: 10.1136/medethics-2015-102858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 09/24/2016] [Accepted: 10/03/2016] [Indexed: 06/07/2023]
Abstract
The ethics of benefit sharing has been a topical issue in global health research in resource-limited countries. It pertains to the distribution of goods, benefits and advantages to the research participants, communities and countries that are involved in research. One of the nuances in benefit sharing is the ethical justification on which the concept should be based. Extensive literature outlining the different principles underlying benefit sharing is available. The purpose of this paper is to examine the proposed principles using Aristotelian principles of justice. The paper assesses the central idea of Aristotelian justice and applies and evaluates this idea to benefit sharing in research, especially when commercial research sponsors conduct research in resource-limited countries. Two categories of Aristotelian justice-universal and particular-were examined and their contribution to the benefit-sharing discourse assessed. On the one hand, benefit sharing in accordance with universal justice requires that for-profit research sponsors obey the legal regulations and international standards set for benefit sharing. On the other hand, benefit sharing in accordance with particular justice transcends obeying legal requirements and standards to a realm of acting in an ethically accepted manner. Accordingly, the paper further examines three perspectives of particular justice and develops ethical justification for benefit sharing in global health research. As Aristotelian justice is still relevant to the contemporary discourse on justice, this paper broadens the ethical justifications of benefit sharing in global health research.
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Abstract
One common objection to establishing regulated live donor organ markets is that such markets would be exploitative. Perhaps surprisingly, exploitation arguments against organ markets have been widely rejected in the philosophical literature on the subject. It is often argued that concerns about exploitation should be addressed by increasing the price paid to organ sellers, not by banning the trade outright. I argue that this analysis rests on a particular conception of exploitation (which I refer to as 'fair benefits' exploitation), and outline two additional ways that the charge of exploitation can be understood (which I discuss in terms of 'fair process' exploitation and complicity in injustice). I argue that while increasing payments to organ sellers may mitigate or eliminate fair benefits exploitation, such measures will not necessarily address fair process exploitation or complicity in injustice. I further argue that each of these three forms of wrongdoing is relevant to the ethics of paid living organ donation, as well as the design of public policy more generally.
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Affiliation(s)
- Julian J Koplin
- Monash Bioethics Centre, Monash University, Melbourne, Australia.
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Wendler D. The Potential for Infrastructure Benefits and the Responsiveness Requirement. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:1-2. [PMID: 27216088 DOI: 10.1080/15265161.2016.1184508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Dauda B, Denier Y, Dierickx K. What Do the Various Principles of Justice Mean Within the Concept of Benefit Sharing? JOURNAL OF BIOETHICAL INQUIRY 2016; 13:281-293. [PMID: 26825296 DOI: 10.1007/s11673-016-9706-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/18/2016] [Indexed: 06/05/2023]
Abstract
The concept of benefit sharing pertains to the act of giving something in return to the participants, communities, and the country that have participated in global health research or bioprospecting activities. One of the key concerns of benefit sharing is the ethical justifications or reasons to support the practice of the concept in global health research and bioprospecting. This article evaluates one of such ethical justifications and its meaning to benefit sharing, namely justice. We conducted a systematic review to map the various principles of justice that are linked to benefit sharing and analysed their meaning to the concept of benefit sharing. Five principles of justice (commutative, distributive, global, procedural, and compensatory) have been shown to be relevant in the nuances of benefit sharing in both global health research and bioprospecting. The review findings indicate that each of these principles of justice provides a different perspective for a different benefit sharing rationale. For example, commutative justice provides a benefit sharing rationale that is focused on fair exchange of benefits between research sponsors and communities. Distributive justice produces a benefit sharing rationale that is focused on improving the health needs of the vulnerable research communities. We have suggested that a good benefit sharing framework particularly in global health research would be more beneficial if it combines all the principles of justice in its formulation. Nonetheless, there is a need for empirical studies to examine the various principles of justice and their nuances in benefit sharing among stakeholders in global health research.
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Affiliation(s)
- Bege Dauda
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, 35 Kapucijnenvoer, Box 7001, B-3000, Leuven, Belgium
| | - Yvonne Denier
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, 35 Kapucijnenvoer, Box 7001, B-3000, Leuven, Belgium.
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, 35 Kapucijnenvoer, Box 7001, B-3000, Leuven, Belgium.
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Mastroleo I. Post-trial obligations in the Declaration of Helsinki 2013: classification, reconstruction and interpretation. Dev World Bioeth 2015; 16:80-90. [PMID: 26481322 DOI: 10.1111/dewb.12099] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The general aim of this article is to give a critical interpretation of post-trial obligations towards individual research participants in the Declaration of Helsinki 2013. Transitioning research participants to the appropriate health care when a research study ends is a global problem. The publication of a new version of the Declaration of Helsinki is a great opportunity to discuss it. In my view, the Declaration of Helsinki 2013 identifies at least two clearly different types of post-trial obligations, specifically, access to care after research and access to information after research. The agents entitled to receive post-trial access are the individual participants in research studies. The Declaration identifies the sponsors, researchers and host country governments as the main agents responsible for complying with the post-trial obligations mentioned above. To justify this interpretation of post-trial obligations, I first introduce a classification of post-trial obligations and illustrate its application with examples from post-trial ethics literature. I then make a brief reconstruction of the formulations of post-trial obligations of the Declaration of Helsinki from 2000 to 2008 to correlate the changes with some of the most salient ethical arguments. Finally I advance a critical interpretation of the latest formulation of post-trial obligations. I defend the view that paragraph 34 of 'Post-trial provisions' is an improved formulation by comparison with earlier versions, especially for identifying responsible agents and abandoning ambiguous 'fair benefit' language. However, I criticize the disappearance of 'access to other appropriate care' present in the Declaration since 2004 and the narrow scope given to obligations of access to information after research.
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Wendler D, Shah S. Involving Communities in Deciding What Benefits They Receive in Multinational Research. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2015; 40:584-600. [PMID: 26224724 PMCID: PMC4573657 DOI: 10.1093/jmp/jhv017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is wide agreement that communities in lower-income countries should benefit when they participate in multinational research. Debate now focuses on how and to what extent these communities should benefit. This debate has identified compelling reasons to reject the claim that whatever benefits a community agrees to accept are necessarily fair. Yet, those who conduct clinical research may conclude from this rejection that there is no reason to involve communities in the process of deciding how they benefit. Against this possibility, the present manuscript argues that involving host communities in this process helps to promote four important goals: (1) protecting host communities, (2) respecting host communities, (3) promoting transparency, and (4) enhancing social value.
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Affiliation(s)
- David Wendler
- National Institutes of Health, Bethesda, Maryland, USA National Institutes of Health, Bethesda, Maryland, USA
| | - Seema Shah
- National Institutes of Health, Bethesda, Maryland, USA National Institutes of Health, Bethesda, Maryland, USA
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11
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Cook K, Snyder J, Calvert J. Attitudes toward Post-Trial Access to Medical Interventions: A Review of Academic Literature, Legislation, and International Guidelines. Dev World Bioeth 2015; 16:70-9. [PMID: 27378034 DOI: 10.1111/dewb.12087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is currently no international consensus around post-trial obligations toward research participants, community members, and host countries. This literature review investigates arguments and attitudes toward post-trial access. The literature review found that academic discussions focused on the rights of research participants, but offered few practical recommendations for addressing or improving current practices. Similarly, there are few regulations or legislation pertaining to post-trial access. If regulatory changes are necessary, we need to understand the current arguments, legislation, and attitudes towards post-trial access and participants and community members. Given that clinical trials conducted in low-income countries will likely continue, there is an urgent need for consideration of post-trial benefits for participants, communities, and citizens of host countries. While this issue may not be as pressing in countries where participants have access to healthcare and medicines through public schemes, it is particularly important in regions where this may not be available.
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12
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Wenner DM. Against Permitted Exploitation in Developing World Research Agreements. Dev World Bioeth 2015; 16:36-44. [DOI: 10.1111/dewb.12081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Unequal treatment of human research subjects is a significant ethical concern, because justice in research involving human subjects requires equal protection of rights and equal protection from harm and exploitation. Disputes sometimes arise concerning the issue of unequal treatment of research subjects. Allegedly unequal treatment occurs when subjects are treated differently and there is a genuine dispute concerning the appropriateness of equal treatment. Patently unequal treatment occurs when subjects are treated differently and there is not a genuine dispute about the appropriateness of equal treatment. Allegedly unequal treatment will probably always occur in research with human subjects due to disagreements about fundamental questions of justice. The best way to deal with allegedly unequal treatment is to promote honest and open discussions of the issues at stake. Research regulations can help to minimize patently unequal treatment by providing rules for investigators, ethical review boards, institutions, and sponsors to follow. However, patently unequal treatment may still occur because the regulations are subject to interpretation. Federal agencies have provided interpretive guidance that can help promote consistent review and oversight of human subjects research. Additional direction may be needed on topics that are not adequately covered by current guidance or regulations. International guidelines can help promote equal treatment of human subjects around the globe. While minor variations in the treatment of research subjects should be tolerated and even welcomed, major ones (i.e. those that significantly impact human rights or welfare) should be avoided or minimized.
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Affiliation(s)
- David B Resnik
- National Institute of Environmental Health Sciences, National Institutes of Health, Box 12233, Mail Drop CU 03, Research Triangle Park, NC, 27709, USA,
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Solbakk JH. What is it to do good medical ethics? On the concepts of 'good' and 'goodness' in medical ethics. JOURNAL OF MEDICAL ETHICS 2015; 41:12-16. [PMID: 25516925 DOI: 10.1136/medethics-2014-102310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In his book The Varieties of Goodness Georg Henrik von Wright advocates that a useful preliminary to the study of the word 'good' is to compile a list of familiar uses and try to group them under some main headings. The present paper aims at exploring the question, 'What is it to do good medical ethics?', and notably from the vantage point of everyday expressions of the word 'good' and von Wright's grouping of them into six different types of goodness.
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Ballantyne A. EXPLOITATION IN CROSS-BORDER REPRODUCTIVE CARE. INTERNATIONAL JOURNAL OF FEMINIST APPROACHES TO BIOETHICS 2014. [DOI: 10.3138/ijfab.7.2.0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Concerns about exploitation pervade the literature on commercial cross-border reproductive care, particularly egg selling and surrogacy. But what constitutes exploitation, and what moral weight does it have? I consider the relationship between vulnerability, limited choice, consent, and mutually advantageous exploitation. To elucidate the difference between limited choice and consent, I draw on an account of relational autonomy. In the absence of a normative principle of fair distribution, it is unclear whether the providers of reproductive goods and services are treated fairly in such contracts, and therefore whether they have been exploited. I finish with some pragmatic recommendations for minimizing risks and empowering egg sellers and surrogates.
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Zvonareva O, Akrong L. Developing Clinical Research Relationship: Views from Within. Dev World Bioeth 2014; 15:257-66. [DOI: 10.1111/dewb.12070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dal-Ré R, Ndebele P, Higgs E, Sewankambo N, Wendler D. Protections for clinical trials in low and middle income countries need strengthening not weakening. BMJ 2014; 349:g4254. [PMID: 24996885 PMCID: PMC4688422 DOI: 10.1136/bmj.g4254] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rafael Dal-Ré
- Clinical Research, BUC (Biosciences UAM+CSIC) Program, International Campus of Excellence, Universidad Autónoma de Madrid, E-28049 Madrid, Spain
| | - Paul Ndebele
- Medical Research Council of Zimbabwe, Causeway, Harare, Zimbabwe
| | - Elizabeth Higgs
- Division of Clinical Research, Office of the Director, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | | | - David Wendler
- Unit on Vulnerable Populations, Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
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Dauda B, Dierickx K. Benefit sharing: an exploration on the contextual discourse of a changing concept. BMC Med Ethics 2013; 14:36. [PMID: 24028325 PMCID: PMC3847211 DOI: 10.1186/1472-6939-14-36] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 09/09/2013] [Indexed: 11/14/2022] Open
Abstract
Background The concept of benefit sharing has been a topical issue on the international stage for more than two decades, gaining prominence in international law, research ethics and political philosophy. In spite of this prominence, the concept of benefit sharing is not devoid of controversies related to its definition and justification. This article examines the discourses and justifications of benefit sharing concept. Discussion We examine the discourse on benefit sharing within three main spheres; namely: common heritage of humankind, access and use of genetic resources according to the Convention on Biological Diversity (CBD), and international clinical research. Benefit sharing has change from a concept that is enshrined in a legally binding regulation in the contexts of common heritage of humankind and CBD to a non-binding regulation in international clinical research. Nonetheless, there are more ethical justifications that accentuate benefit sharing in international clinical research than in the contexts of common heritage of humankind and the CBD. Summary There is a need to develop a legal framework in order to strengthen the advocacy and decisiveness of benefit sharing practice in international health research. Based on this legal framework, research sponsors would be required to provide a minimum set of possible benefits to participants and communities in research. Such legal framework on benefit sharing will encourage research collaboration with local communities; and dispel mistrust between research sponsors and host communities. However, more research is needed—drawing from other international legal frameworks, to understand how such a legal framework on benefit sharing can be successfully formulated in international health research.
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Affiliation(s)
- Bege Dauda
- Centre for Biomedical Ethics and Law, Faculty of Medicine KU Leuven, Kapucijnenvoer 35, Box 7001, Leuven B-3000, Belgium.
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Zvonareva O, Engel N, Ross E, Berghmans R, Dhai A, Krumeich A. Engaging diverse social and cultural worlds: perspectives on benefits in international clinical research from South african communities. Dev World Bioeth 2013; 15:8-17. [PMID: 23725088 DOI: 10.1111/dewb.12030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The issue of benefits in international clinical research is highly controversial. Against the background of wide recognition of the need to share benefits of research, the nature of benefits remains strongly contested. Little is known about the perspectives of research populations on this issue and the extent to which research ethics discourses and guidelines are salient to the expectations and aspirations existing on the ground. This exploratory study contributes to filling this void by examining perspectives of people in low-income South African communities on benefits in international clinical research. Twenty-four individuals with and without experience of being involved in clinical research participated in in-depth interviews. Respondents felt that ancillary care should be provided to clinical research participants, while a clinical study conducted in particular community should bring better health to its members through post-trial benefits. Respondents' perspectives were grounded in the perception that the ultimate goal of international clinical research is to improve local health. We argue that perspectives and understandings of the respondents are shaped by local moral traditions rather than clinical research specificities and require attention as valid moral claims. It is necessary to acknowledge such claims and cultural worlds from which they emerge, thus building the foundation for equal and embracing dialogue to bridge different perspectives and handle contradicting expectations.
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Yassi A, Breilh J, Dharamsi S, Lockhart K, Spiegel JM. The Ethics of Ethics Reviews in Global Health Research: Case Studies Applying a New Paradigm. JOURNAL OF ACADEMIC ETHICS 2013. [DOI: 10.1007/s10805-013-9182-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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In the ruins of Babel: pitfalls on the way toward a universal language for research ethics and benefit sharing. Camb Q Healthc Ethics 2011; 20:341-55. [PMID: 21676322 DOI: 10.1017/s096318011100003x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
At the end of a paper on international research ethics published in the July-August 2010 issue of the Hastings Center Report, London and Zollman argue the need for grounding our duties in international medical and health-related research within a broader normative framework of social, distributive, and rectificatory justice. The same goes for Thomas Pogge, who, in a whole range of publications during the past years, has argued for a human-rights-based approach to international research. In a thought-provoking paper in the June 2010 issue of the American Journal of Bioethics, Angela J. Ballantyne argues that “the global bioethics priority” in medical and health-related research ethics today is how to do research fairly in an unjust world.
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Olivier C, Williams-Jones B. Pharmacogenomic technologies: a necessary "luxury" for better global public health? Global Health 2011; 7:30. [PMID: 21864366 PMCID: PMC3175439 DOI: 10.1186/1744-8603-7-30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 08/24/2011] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Pharmacogenomic technologies aim to redirect drug development to increase safety and efficacy of individual care. There is much hope that their implementation in the drug development process will help respond to population health needs, particularly in developing countries. However, there is also fear that novel pharmacogenomic drugs will remain too costly, be designed for the needs of the wealthy nations, and so constitute an unnecessary "luxury" for most populations. In this paper, we analyse the promise that pharmacogenomic technologies hold for improving global public health and identify strategies and challenges associated with their implementation. DISCUSSION This paper evaluates the capacity of pharmacogenomic technologies to meet six criteria described by the University of Toronto Joint Centre for Bioethics group: 1) impact of the technology, 2) technology appropriateness, 3) capacity to address local burdens, 4) feasibility to be implemented in reasonable time, 5) capacity to reduce the knowledge gap, and 6) capacity for indirect benefits. We argue that the implementation of pharmacogenomic technologies in the drug development process can positively impact population health. However, this positive impact depends on how and for which purposes the technologies are used. We discuss the potential of these technologies to stimulate drug discovery in the case of rare (orphan diseases) or neglected diseases, but also to reduce acute adverse drug reactions in infectious disease treatment and prevention, which promises to improve global public health. CONCLUSIONS The implementation of pharmacogenomic technologies may lead to the development of drugs that appear to be a "luxury" for populations in need of numerous interventions that are known to have a demonstrable impact on population health (e.g., secure access to potable water, reduction of social inequities, health education). However, our analysis shows that pharmacogenomic technologies do have the potential to redirect drug development and distribution so as to improve the health of vulnerable populations. Strategies should thus be developed to better direct their implementation towards meeting the needs and responding to the realities of populations of the developing world (i.e., social, cultural and political acceptability, and local health burdens), making pharmacogenomic technologies a necessary "luxury" for global public health.
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Affiliation(s)
- Catherine Olivier
- Bioethics Programs, Department of Social and Preventive Medicine, Université de Montréal, Montréal, Canada
| | - Bryn Williams-Jones
- Bioethics Programs, Department of Social and Preventive Medicine, Université de Montréal, Montréal, Canada
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Psychiatric ethics: foundational and evolutionary. J Nerv Ment Dis 2011; 199:562-6. [PMID: 21814079 DOI: 10.1097/nmd.0b013e318225f0fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As with the basic and clinical sciences, the field of medical ethics, in particular, that of psychiatric ethics, has grown and developed during the last four decades, the time when Dr. Eugene Brody edited the Journal of Nervous and Mental Disease. In this paper, the authors will consider a series of ethical problems that psychiatrists have identified in their clinical practice and suggest paths to resolution that may artfully balance conflicts in core moral beliefs.
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25
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Resnik DB. Practical and political problems with a global research tax. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:44-45. [PMID: 20526971 PMCID: PMC3967843 DOI: 10.1080/15265161.2010.481347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- David B Resnik
- National Institute of Environmental Health Sciences, National Institutes of Health, Mail Drop NH06, Box 12233, Research Triangle Park, NC 27709, USA.
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26
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MacDonald C, Walton N. The perverse consequences of a proposed global tax on research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:46-47. [PMID: 20526972 DOI: 10.1080/15265161.2010.482641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Chris MacDonald
- Department of Philosophy, Saint Mary's University, 923 Robie St., Halifax B3H3C3, Nova Scotia.
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McMillan J. Human rights: the normative engine of fairness and research in developing countries. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:47-49. [PMID: 20526973 DOI: 10.1080/15265161003728811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- John McMillan
- School of Medicine, Room 5E: 209, Flinders Medical Centre, GPO Box 2100, Adelaide SA 5001, Australia.
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Ozdemir V, Knoppers BM. One size does not fit all: toward "upstream ethics"? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:42-44. [PMID: 20526970 DOI: 10.1080/15265161.2010.482639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Vural Ozdemir
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, C.P. 6128, Succ. Centre-ville, Montreal, Qéebec H3C3J7, Canada.
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Rossi J. International research and positive obligations: are they "transaction specific"? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:49-51. [PMID: 20526974 DOI: 10.1080/15265161.2010.482633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- John Rossi
- Office of Pediatric Therapeutics, Food and Drug Administration, 10903 New Hampshire Ave., Building 32, Room 5165, Silver Spring, MD 20993, USA.
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Ballantyne AJ. Response to open peer commentaries on "How to do research fairly in an unjust world". THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:W4-W6. [PMID: 20526959 DOI: 10.1080/15265161.2010.492747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Angela J Ballantyne
- Donaghue Initiative in Biomedical and Behavioral Research Ethics, Interdisciplinary Center for Bioethics, ISPS, Yale University, 77 Prospect Street, PO Box 208209, New Haven, CT 06520, USA.
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London AJ. Justice in the application of science: beyond fair benefits. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:54-56. [PMID: 20526976 DOI: 10.1080/15265161.2010.483184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Alex John London
- Philosophy Department, Carnegie Mellon University, 135 Baker Hall, Pittsburgh, PA 15213-3890, USA.
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Schuklenk U. For-profit clinical trials in developing countries--those troublesome patient benefits. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:52-54. [PMID: 20526975 DOI: 10.1080/15265161.2010.483183] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Udo Schuklenk
- Department of Philosophy, Queen's University, Watson Hall 308, Kingston K3L3N6, ON, Canada.
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Wertheimer A, Millum J, Schaefer GO. Why adopt a maximin theory of exploitation? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:38-39. [PMID: 20526968 DOI: 10.1080/15265161.2010.482635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Alan Wertheimer
- Department of Bioethics, National Institutes of Health, 10 Center Dr, The Clinical Center, Building 10, Bethesda, MD 20892-1156, USA.
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Snyder J. Multiple forms of exploitation in international research: the need for multiple standards of fairness. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:40-41. [PMID: 20526969 DOI: 10.1080/15265161.2010.482631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall 10516, 8888 University Drive, Burnaby BC V5A1S6, Canada.
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Macklin R. Fair benefits in developing countries: maximin as a good start. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:36-37. [PMID: 20526967 DOI: 10.1080/15265161.2010.482648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Ruth Macklin
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
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Abstract
The need for good research in psychiatry has never been more important than in this era of 'Evidence-based medicine' (EBM).[1] The countries in south Asia have to rise to the challenge and abandon the emphasis placed on 'Experiencebased medicine', as was popular in the traditional systems of medicine - the art was handed down from father to son or guru to shishya (student).Evidence-based medicine does not abandon clinician experience, skills, and judgment, but rather complements it with the best available evidence and patient choice.[2] This article explores the challenges in obtaining the best available evidence in the south Asian context.
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