This seminal collection on the ethical issues associated with infectious disease is the first book to correct bioethics’ glaring neglect of this subject. Timely in view of public concern about SARS, AIDS, avian flu, bioterrorism and antibiotic resistance. Brings together new and classic papers by prominent figures. Tackles the ethical issues associated with issues such as quarantine, vaccination policy, pandemic planning, biodefense, wildlife disease and health care in developing countries.

Standard medical ethical analyses typically focus on the physician/patient relationship, patient autonomy, and the clinical encounter. For Liberation Theology this amounts to neglecting the larger context of social injustice. Medicine is a social institution. Any medical ethics which purports to provide an ethics of medicine and medical practice must necessarily address the larger social issues of class structure, poverty and access to adequate health care. Liberation Theology provides a very specific perspective that draws on the needs of the poverty stricken, (...) assesses the relationship among social classes, and focuses on societal conditions. Given such an analysis, medical ethics is reconfigured as concerned not only with clinical encounters but also with background cultural conditions and social justice. (shrink)

The maternal‐fetal HIV transmission trials, conducted in developing countries in the 1990s, undoubtedly generated one of the most intense, high profile controversies in international research ethics. They sparked off a prolonged acrimonious and public debate and deeply divided the scientific community. They also provided an impetus for the revision of the Declaration of Helsinki – the most widely known guideline for international research. In this paper, I provide a brief summary of the context, outline the arguments for and against the (...) controversial use of placebo controls, and focus on particular areas that I believe merit further discussion or clarification. On balance, I argue that the researchers failed in their duties to protect the best interests of their research subjects, and to promote distributive justice. I discuss the difficulties of obtaining valid consent in this research context, and argue that it is unethical to inform women of their HIV status without at least offering them prophylactic treatment for their unborn children. A global view of justice, which endorses international equity, cannot be squared with international research guidelines that allow ‘local conditions’ to define the scope of duty to the control group. Finally, I suggest that the heated debate reflects a tension, if not an outright war, between two conflicting meta‐ethical systems, or incommensurable paradigms, that underpin scientific research involving human subjects. (shrink)

This paper discusses a dispute concerning the ethics of research on preventing the perinatal transmission of HIV in developing nations. Critics of this research argue that it is unethical because it denies a proven treatment to placebo‐control groups. Since studies conducted in developed nations would not deny this treatment to subjects, the critics maintain that these experiments manifest a double standard for ethical research and that a single standard of ethics should apply to all research on human subjects. Proponents of (...) the research, however, argue that these charges fail to understand the ethical complexities of research in developing nations, and that study designs can vary according to the social, economic, and scientific conditions of research. This essay explores some of the ethical issues raised by this controversial case in order to shed some light on the deeper, meta‐ethical questions. The paper argues that standards of ethical research on human subjects are universal but not absolute: there are some general ethical principles that apply to all cases of human subjects research but the application of these principles must take into account factors inherent in particular situations. (shrink)

Standard medical ethical analyses typically focus on the physician/patient relationship, patient autonomy, and the clinical encounter. For Liberation Theology this amounts to neglecting the larger context of social injustice. Medicine is a social institution. Any medical ethics which purports to provide an ethics of medicine and medical practice must necessarily address the larger social issues of class structure, poverty and access to adequate health care. Liberation Theology provides a very specific perspective that draws on the needs of the poverty stricken, (...) assesses the relationship among social classes, and focuses on societal conditions. Given such an analysis, medical ethics is reconfigured as concerned not only with clinical encounters but also with background cultural conditions and social justice. (shrink)