Medical Research Ethics Challenges In The 21st Century

This book provides a current review of Medical Research Ethics on a global basis. The book contains chapters that are historically and philosophically reflective and aimed to promote a discussion about controversial and foundational aspects in the field. An elaborate group of chapters concentrates on key areas of medical research where there are core ethical issues that arise both in theory and practice: genetics, neuroscience, surgery, palliative care, diagnostics, risk and prediction, security, pandemic threats, finances, technology, and public policy.This book is suitable for use from the most basic introductory courses to the highest levels of expertise in multidisciplinary contexts. The insights and research by this group of top scholars in the field of bioethics is an indispensable read for medical students in bioethics seminars and courses as well as for philosophy of bioethics classes in departments of philosophy, nursing faculties, law schools where bioethics is linked to medical law, experts in comparative law and public health, international human rights, and is equally useful for policy planning in pharmaceutical companies.

Medical care and biomedical research are rapidly becoming global. Ethical questions that once arose only in the narrow context of the physician-patient relationship in relatively prosperous societies are now being raised across societies, cultures, and continents. For example, what should be the "standard of care" for clinical trials of medical innovations in poorer countries? Are researchers obligated to compare new therapies or drugs with the best known ones available, or can they use as a benchmark the actual treatments (or lack of treatments) available to poor people? Should pharmaceutical companies seeking to lower the costs of new drug trials be allowed to enrol citizens of less developed countries in them even when those individuals cannot afford and will not be eligible for the resulting drugs? More generally, should the norms of medicine and research be the same across cultures or can they adapt to local social, economic, or religious conditions? Global Bioethics gathers some of the world's leading bioethicists to explore many of the new questions raised by the globalization of medical care and biomedical research. Among the topics covered are the impact of globalization on the norms of medical ethics, the conduct of international research, the ethics of international collaborations, challenges to medical professionalism in the international setting, and the relation of religion to global bioethics.

Bioethics is primarily an applied ethics of health related issues. It is considered an important guide for health care and its discourses and practices. Health related technology, such as information technology, is changing rapidly. Bioethics should arguably address such change as well as continue to address more established areas of health care and emerging areas of social concern such as climate change and its relation to health. This book illustrates the range of bioethics in the 21st century. The book is intentionally not comprehensive but rather illustrative of established, emerging and speculative bioethics, such as ethics of mental health care, ethics of nano-technology in health care, and ethics of cryogenics, respectively. Hopefully the book will motivate readers to reflect on health care as a work in progress that requires continuous ethical deliberation and guidance.

As a scientific, materialist worldview becomes increasingly difficult to repudiate, and as philosophers increasingly uncover and articulate the conceptual nature of morality and distinctively moral normativity, the threat of moral anti-realism becomes more and more real. This perspective is argued in Chapter One. Chapter Two discusses how laws and bioethical trends that pertain to the clinical management of patients in a vegetative coma differ from country to country and continue to give rise to unresolved legal debates and scientific controversy. Chapter Three covers how caregivers in palliative care must be supported to better understand patients hopes and needs, making them comfortable to decide when or how much they want to eat. Chapter Four synthesises findings from four empirical studies conducted in Western Africa (Togo) on topics related to the autonomy (end of life decision-making among terminally-ill patients), benevolence and non-malevolence (breaking bad news to elderly patients and their families), and justice (informal payments to physicians, criminal prosecution in cases of HIV transmission) principles of bioethics. Finally, Chapter Five argues that expert members in Ethics committees have an unfair upper-hand, with their decisions trumping other debates in committee deliberations. Qualitative research is brought to bear which illustrates this and which also notes how expertise dilutes the training given to newly appointed ethics committee members.

This book teaches researchers how to resolve the ethical dilemmas that can arise at any stage in clinical research. In addition to explaining pertinent regulations and laws, Dr. Lo helps investigators understand the gaps and uncertainties in regulations, as well as situations in which merely complying with the law may not fulfill ethical responsibilities. Most chapters include real-life examples that the author walks through, discussing the salient issues and how to approach them. This book can be used in courses on research ethics that are required or encouraged by major National Institutes of Health grants in academic health centers.

This review considers ethical challenges to research design and informed consent in biomedical and behavioral studies conducted in resource-poor settings. A review of the literature explores relevant social, cultural, and ethical issues in the conduct of biomedical and social health research in developing countries. Ten case vignettes illustrate ethical challenges that arise in international research with culturally diverse populations. Recommendations for researchers and policy-makers concerned about ethical practices in multinational studies conducted in resource-poor settings are also listed.