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. (shrink)

It is commonly thought that exploitation is unjust; some think it is part of the very meaning of the word 'exploitation' that it is unjust. Those who think this will suppose that the just society has to be one in which people do not exploit one another, at least on a large scale. I will argue that exploitation is not unjust by definition, and that a society (such as Our own) might be fundamentally just while nevertheless being pervasively exploitative. I (...) do think that exploitation is nearly always a bad thing, and will try to identify the moral belief which makes most of us think it is. But I will argue that its badness does not always consist in its being unjust. (shrink)

In this article, the main complexities of understanding and curbing the HIV/AIDS pandemic in (South) Africa, are discussed. These are: 1. Poverty as niche or social context of the pandemic, 2. Denial, lack of leadership and the politicization of the public discourse on AIDS, 3. Problems related to accomplishing behavior changes under conditions of deprivation and illiteracy, 4. Women's vulnerability, and 5. The disenchantment of intimacy brought about by the pandemic. In each case, some solutions are suggested, although the notion (...) of complexity does not allow for definitive solutions. Concluding remarks deal with the possible philosophical and moral sense that we might make of the pandemic. (shrink)

Philoctetes was a good man and a good soldier. When he was on his way to Troy to fight alongside the Greeks, he had a terrible misfortune. By sheer accident he trespassed in a sacred precinct on the island of Lemnos. As punishment he was bitten on the foot by the serpent who guarded the shrine. His foot began to ooze with foul-smelling pus, and the pain made him cry out curses that spoiled the other soldiers' religious observances. They therefore (...) left him alone on the island, a lame man with no resources but his bow and arrows, no friends but the animals who were also his food. Ten years later, according to Sophocles' version of the story, they come to bring him back: for they have learned that they cannot win the war without him. The leaders of the expedition think of Philoctetes as a tool of their purposes; they plan to trick him into returning, with no empathy for his plight. The Chorus of soldiers, however, has a different response. Even before they see the man, they imagine vividly what it is like to be him– and they enter a protest against the callousness of the commanders: For my part, I pity him– thinking of how, with no living soul to care for him, seeing no friendly face, wretched, always alone, he suffers with a fierce affliction, and has no resources to meet his daily needs. How in the world does the poor man survive? (shrink)

: Following a long process of revision, a new version of the Declaration of Helsinki was approved by the World Medical Association in 2000. Two provisions of the Declaration address ongoing international controversies regarding research sponsored by industrialized countries and conducted in developing countries. Despite the issuance of the final version of the Declaration, opponents remain locked in debate. Moreover, the Declaration remained silent on other prominent controversies concerning international research. An analysis of these current controversies reveals reasons why they (...) are not likely to be readily resolved, despite apparent agreement by opponents on overarching ethical principles. (shrink)

Over the past two years, much has been made by some governments and the media about the possible callous and racist distribution of Quinacrine by two Americans to sterilize women in the Third World. The main criticism of the practice is that though Quinacrine is unapproved by the developed world's health regulatory agencies for this particular use in the developed world due to inadequate testing for long-term side effects, it is used on defenseless women in the developing world.I argue that (...) the distribution of unapproved medical and other products is morally permissible if it satisfies two conditions: agent-centered utilitarianism and Kant's Categorical Imperative. Roughly, I contend that if the situation will probably improve and no one is treated as a mere means, then it is ethical either to give or to sell the products to those who choose to have them, regardless of where in the world they live. (shrink)

It is commonly thought that exploitation is unjust; some think it is part of the very meaning of the word ‘exploitation’ that it is unjust. Those who think this will suppose that the just society has to be one in which people do not exploit one another, at least on a large scale. I will argue that exploitation is not unjust by definition, and that a society might be fundamentally just while nevertheless being pervasively exploitative. I do think that exploitation (...) is nearly always a bad thing, and wul try to identify the moral belief which makes most of us think it is. But I will argue that its badness does not always consist in its being unjust. (shrink)