Kantian ethics, exploitation, and multinational clinical trials

Exploitation and Developing Countries: The Ethics of Clinical Research

Volumn , Issue , 2008, Pages 175-205

  Siegel, Andrew W ^a  

^a NONE

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EID: 84890610569     PISSN: None     EISSN: None     Source Type: Book    
DOI: None     Document Type: Chapter

References (27)

1. Immanuel Kant, "On the Proverb: That May Be True in Theory, But Is of No Practical Use," in Perpetual Peace and Other Essays, trans.Ted Humphrey (Indianapolis: Hackett, 1992), 89.
2. This point is consistent with the "fair benefits" view, which, in dissent from the general consensus, holds that collateral health benefits from the conduct of research may suffice to prevent exploitation. See "Moral Standards for Research in Developing Countries: From 'Reasonable Availability' to 'Fair Benefits,'" Hastings Center Report 34, no. 3 (2004): 17-27.
3. Immanuel Kant, Groundwork for the Metaphysics of Morals, trans. J. W. Ellington (Indianapolis: Hackett, 1993), 421.
4. Some Kant commentators have argued that we should view his conceptual contradiction test as strictly concerned with logical impossibility, while others have argued that it is practical impossibility that matters. For the former, see A.Wood, "Kant on False Promises," Proceedings of the Third International Kant Congress, ed. L.W. Beck (Dordrecht: D. Reidel, 1972); for the latter
5. see Christine Korsgaard, "Kant's Formula of Universal Law," in Creating the Kingdom of Ends (Cambridge: Cambridge University Press, 1996).
6. Barbara Herman, "Murder and Mayhem," in The Practice of Moral Judgment (Cambridge, MA: Harvard University Press, 1993).
7. Barbara Herman, "Moral Deliberation and the Derivation of Duties," in The Practice of Moral Judgment, 154. This idea is nicely captured in Philip Roth's Everyman, in a character's reflections on her husband's lies about an affair: "Lying is cheap, contemptible control over the other person. It's watching the other person acting on incomplete information-in other words, humiliating herself." Philip Roth, Everyman (New York: Houghton Mifflin, 2006), 121.
8. See Herman, "Mutual Aid and Respect for Persons," in The Practice of Moral Judgment; and Onora O'Neil, "Universal Laws and Ends-in-Themselves," in Contructions of Reason (Cambridge: Cambridge University Press, 1989).
9. This is in fundamental opposition to consequentialist and modern decision-theoretic accounts, which view rational choice as serving a merely instrumental role in producing valuable states of affairs.
10. Christine Korsgaard, "Kant's Formula of Humanity," in Creating the Kingdom of Ends.
11. Allen Wood, Kant's Ethical Thought (Cambridge: Cambridge University Press, 1999), 130.
12. As Korsgaard argues, the deceiver treats persons as mere means because he treats an agent's reason "as a mediate rather than a first cause." Korsgaard, "The Right to Lie," in Creating the Kingdom of Ends, 141.
13. Immanuel Kant, The Metaphysics of Morals, trans. and ed. Mary Gregor (Cambridge: Cambridge University Press, 1996), 463, 465.
14. Council for International Organizations of Medical Sciences (CIOMS), International Ethical Guidelines for Biomedical Research Involving Human Subjects (1993), Commentary on Guideline 8, at 25.
15. George Annas and Michael Grodin, "Human Rights and Maternal-Fetal HIV Transmission Prevention Trials in Africa," American Journal of Public Health 88 (1998): 560-63, at 562.
16. Allen Wood, "Exploitation," in Exploitation, ed. K.Neilsen and R.Ware (New York: Humanities Press, 1997), 2-26, at 15.
17. The standard view has been that Kant supports only a minimalist state, which is limited to protecting individuals from interferences with their freedom. For some recent challenges to this view, see Alexander Kaufman,Welfare in the Kantian State (Oxford:Oxford University Press, 1999); and Allen Rosen, Kant's Theory of Justice (Ithaca, NY: Cornell University Press, 1993).
18. C. R. Beitz, "Does Global Inequality Matter?" in Global Justice, ed. Thomas Pogge (Oxford: Blackwell, 2001), 115.
19. Thomas Hill, "Kant on Imperfect Duty and Supererogation," in Dignity and Practical Reason in Kant's Moral Philosophy (Ithaca, NY: Cornell University Press, 1992), 147-73.
20. One might argue that even the person who falsely believes that all relief organizations are ineffective displays indifference. For one who makes an effort at educating oneself about relief organizations would learn that many are quite effective; and a person who adopted the maxim of beneficence would presumably wish to educate herself about such matters.
21. The only exception would be in the very rare instance that even the most minimal contribution would undermine one's being well-off.
22. GlaxoSmithKline 2001 Annual Report.
23. See, e.g., Benjamin Freedman, K. C. Glass, and Charles Weijer, "Placebo Orthodoxy in Clinical Research II: Ethical, Legal, and Regulatory Myths," Journal of Law, Medicine and Ethics 24 (1996): 252-59, at 253;World Medical Association, "Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects," Journal of the American Medical Association 284 (2000): 3043- 45.
24. See, e.g., C. Grady, "Science in the Service of Healing," Hastings Center Report 28, no. 6 (1998): 34-38, at 36;
25. S. Salim and K. Abdool, "Placebo Controls in HIV Perinatal Transmission Trials: A South African's Viewpoint," American Journal of Public Health 88 (1998): 564-66, at 565.
26. Franklin Miller and Howard Brody, "What Makes Placebo-Controlled Trials Unethical?" American Journal of Bioethics 2, no. 2 (2002): 3-9, at 4.
27. In the Surfaxin trial, it is possible that considerations of cost were not trivial. The cost for surfactant treatments is $1,100 to $2,400 per newborn. In a trial with several hundred individuals receiving the treatment, the cost could be significant, especially if the biotech company is a small one. This is not to deny that there is an obligation to provide the existing treatment as the control in the Surfaxin case. But it is not as clear-cut a case as Case 1 is.