The last 20 years have seen a staggering growth in the practice of off-shoring clinical research to low-and middle-income countries (LICs and MICs), a growth that has been matched by the neoliberal policies adopted by host countries towards attracting trials to their shores. A recurring concern in this context is the charge of exploitation, linked to various aspects of off-shoring. In this paper, I examine Alan Wertheimer's approach and offer an alternative view of understanding exploitation in this context. I will (...) suggest that the justification for the enterprise of research is largely dependent on its integration within a health system from which participants regularly benefit and I argue that an attention to a principle of reciprocity will enable us to better recognize and address exploitation in international research. (shrink)

Most bioethicists who address questions to which global justice matters have not considered the significance of the disputes over the correct theory of global justice. Consequently, the significance of the differences between theories of global justice for bioethics has been obscured. In this paper, I consider when and how these differences are important. I argue that certain bioethical problems can be resolved without addressing disagreements about global justice. People with very different views about global justice can converge on the existence (...) of a duty to aid the very badly off — those in absolute poverty — wherever they may be. However, despite agreement on extreme cases, there should be disagreement over the extent of international obligations to those who are only relatively poor. Consequently, different theories of justice will diverge in their implications for a number of important problems in contemporary bioethics. I close by sketching in more detail two contemporary bioethical issues —concerning pharmaceutical patents and the health worker brain drain —and show how responses to them might be developed by cosmopolitan and statist liberals. (shrink)

Opposition to inducement payments for research subjects is an international orthodoxy amongst writers of ethics committee guidelines. We offer an argument in favour of these payments. We also critically evaluate the best arguments we can find or devise against such payments, and except in one very limited range of circumstances, we find these unconvincing.

Consensus is lacking among research ethicists on the question of how broadly to understand the requirements of non-exploitation in international clinical research. Two types of principles have been proposed, minimalist and non-minimalist, grounded in two opposing conceptions of exploitation, transactional and systemic. Transactionalists have offered principles, which, it has been argued, are satisfied by minimal gains to vulnerable subjects measured against an unjust status quo. Systemicists have advanced principles with decidedly non-minimal mandates but only by conflating the obligations of clinical (...) research with those of First World citizenship. My aim here is to break this deadlock by offering grounds for a non-minimal requirement of international research ethics grounded in a transactional conception of exploitation. I do this by arguing that a subject's gains must be measured not only within the transaction, relative to her own starting point and to the share of gains enjoyed by her co-transactor, but also across transactions, so as to ensure parity of benefit to trial participants whenever, and wherever, parity of burden is assumed. (shrink)