Ethical Consideration On Exploitation Issue Of International Human Research

With the development of human research globalization, there is public concern about ethical issues of externally-sponsored international human research conducted in developing countries. International human research conducted in developing countries has three unique aspects: first, International human research does not necessarily meet the health needs and priorities of developing countries; second, the risk totally borne by human subjects of the developing countries; third, the accessibility of successful products is uncertain. The majority of developing countries only have limited regulations and ineffective ethics review system of human research, which have led to lively debate on some ehtical issues related to exploitation for more than twenty years, such as: the double standards of medical care within placebo-control trial, the validity of informed consent, and the fair benefit sharing of human research.The dissertation analyzed five important representatives of contemporary North American bioethicist’s conceptions of exploitation for international human research and their positions. Based on a simple concept of exploitation, Alan Wertheimer divided into harmful exploitation and mutually advantageous exploitation according to the fact that whether the exploited benefits from the exploitative transaction or not,and the exploitation can be divided into consensual exploitation and non-consensual exploitation based on whether the exploited offer his / her consent or not. Alan Wertheimer justified that the harmful and nonconsensual exploitation should be forbidden,but if the international human research is the consensual and mutually advantageous exploitation which can be permitted. Angela Ballantyne followed the Alan Wertheimer’s conception of exploitation, but not accepted his conclusion totally,she offered a framework for assessing exploitation in mutually advantageous transaction, aim to discuss ways of reducing rather than eliminating exploitation in mutually advantageous transactions. Jennifer s. Hawkins criticized the medical model of researcher obligations is incoherent, but abandoning the medical model does not lead to the conclusion that all placebo trial cases are morally permissible,researchers have Good Samaritan obligation, if the researcher failed this imperfect duty, there will be a kind of non-harmful exploitation. Based on the Kantianism, Andrew Siegel offers a theory of exploitation that involves three general types of exploitation: namely, exploitation involving the subversion of rationalagency which is relatively satisfying with the requirements of informed consent; and the exploitation involving the degradation of persons which is relative to the inequalities in wealth and power that characterize the relations between research sponsors and research subjects. She thinks that the most profound and pervasive form of exploitation in international human research is the one which involve the violation of the duty of beneficence. There are two kinds of wrongs after violating the duty of beneficence. The first is exploitation which means A is not only indifferent to B’s needs and but also securing a benefit from the interaction with B.The second is indifference that A displays toward B’s essential needs as a rational agent. Based on her tentative exploitation conception, Ruth Macklin analyzed the five candidates for circumstance of exploitation in international human research, and emphasized the fact that the developing countries should strive to reduce the possibility of exploitation in international human research.Based on the perspective of Marxist theory, the advantages and limitations of the North American scholars’ viewpoints have been evaluated. Though North American scholars have different conceptions of exploitation, but all rejected the conception of Marxist exploitation and a certain kind of permissible exploitation position. Among these scholars, Alan Wertheimer is in the most radical position: the non-consensual, harmful exploitation should be forbidden but consensual and mutually advantageous exploitation is permissible. The fundamental flaw of these scholars’ non-Marxist exploitation lies in focusing on the micro level analysis, which are limited to the exchange field and exchange justice. The dissertation puts forward the Marxist permissible exploitation: according to the lower productivity of developing countries, there are certain types of exploitation. However, with strong critical spirit and the enterprising spirit, eliminating exploitation is the inevitable goal of the Marxist theory.The strategies and solutions proposed by the North American scholars to deal with exploitation of the international human trials have been explored. Ezekiel j.Emanuel rejected the reasonable availability requirement and advocated a fair benefits framework to avoid exploitation. Professor Alex John Landon sharply criticized the fair benefit framework and recommended the human development approach. Angela Ballantyne, who concerns the basic needs of the developing countries poverty groups, put forward the strategy of international tax of international human research based on a maximin principle of fair distribution.Based on the theory of global justice, Thomas Pogge offers the innovative strategy of Health Impact Fund(HIF) with great insight. These insights inspire us that the ethical consideration on international human research ethical debate requires the guidance of global justice theory. According to the perspective of governance, the relationship between the international human research governance and the global health governance is clarified. The target of the international human research governance is that the international human research should contribute to a better life and health for all of humanity, rather than only a few developed countries and wealthy citizens in the world. With the favorable interaction between global governance and national governance, the international human research can be conducted in a more just, fair and transparent way.