Who is my brother's keeper?

Full Abstract

Clinical and research practices designed by developed countries are often implemented in host nations of the Third World. In recent years, a number of papers have presented a diversity of arguments to justify these practices which include the defence of research with placebos even though best proven treatments exist; the distribution of drugs unapproved in their country of origin; withholding of existing therapy in order to observe the natural course of infection and disease; redefinition of equipoise to a more bland version, and denial of post-trial benefits to research subjects. These practices have all been prohibited in developed, sponsoring countries, even though they invariably have pockets of poverty where conditions comparable to the Third World prevail. Furthermore, the latest update of the Declaration of Helsinki clearly decries double ethical standards in research protocols. Under these circumstances, it does not seem appropriate that First World scholars should propose and defend research and clinical practices with less stringent ethical standards than those mandatory in their own countries. Recent years have witnessed frequent reports of less stringent ethical standards being applied to both clinical and research medical practices, for the most part in the field of drug trials and drug marketing, initiated by developed countries in poorer nations. Still more unsettling, a number of articles have endorsed the policy of employing ethical norms in these host countries, which would be unacceptable to both the legislations and the moral standards of the sponsor nations. Also, these reformulations often contravene the Declaration of Helsinki or one of its updates. This paper is not so much concerned with the actual practices, which have been subjected to frequent scrutiny and publicly decried when gross misconduct occurred. Rather, my concern relates to the approval and support such practices have found in the literature on bioethics from authors who might be expected to use their energy and scholarship to explore and endorse the universalisability of ethics rather than to develop ad hoc arguments that would allow exceptions and variations from accepted moral standards. To this purpose, issue will be taken with arguments in three fields:
medical and pharmaceutical practices, research strategies, and local application of research results.

Learn Faster Today Improve your study skills

Author information

Author/s: Kottow, M H (MH);

Affiliation: Faculty of Medicine and Faculty of Philosophy and Humanities, University of Chile, Santiago, Chile. kottow@hotmail.com

Journal and publication information

Publication Type: Journal Article; Review

Journal: Journal of medical ethics (J Med Ethics), published in England. (Language: eng)

Reference: 2002-Feb; vol 28 (issue 1) : pp 24-7

Dates: Created 2002/02/08; Completed 2002/03/14; Revised 2007/11/15;

PMID: 11834755, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Bioethics
Clinical Protocols - standards
Clinical Trials as Topic - standards
Control Groups
Decision Making
Developed Countries
Developing Countries
Ethical Relativism
Helsinki Declaration

This article has not been indexed for related articles as yet, however you can still use the live related article search links below.

See 100+ related articles.