This chapter contains sections titled: Introduction Medical Migration and Moral Responsibility Lending Money to Developing Countries Culture and Religion Health Research and Resources Conclusions References.

This paper discusses the economic, legal, moral, and political difficulties in developing drugs for the developing world. It argues that large, global pharmaceutical companies have social responsibilities to the developing world, and that they may exercise these responsibilities by investing in research and development related to diseases that affect developing nations, offering discounts on drug prices, and initiating drug giveaways. However, these social responsibilities are not absolute requirements and may be balanced against other obligations (...) and commitments in light of economic, social, legal, political, and other conditions. How a company decides to exercise its social responsibilities to the developing world depends on the prospects for a reasonable profit and the prospects for a productive business environment. Developing nations can either help or hinder the pharmaceutical industry’s efforts to exercise social responsibility through various policies and practices. To insure that companies can make a reasonable profit, developing nations should honor pharmaceutical product patents and adhere to international intellectual property treaties, such as the Trade‐Related Aspects of Intellectual Property Rights agreement. To insure the companies have a good business environment, developing nations should try to promote the rule of law, ethical business practices, stable currencies, reliable banking systems, free and open markets, democracy, and other conditions conducive to business. Overall, this paper advocates for reciprocity and cooperation between pharmaceutical companies and developing nations to address the problem of developing drugs for the developing world. In pursuing this cooperative approach, developing nations may use a variety of other techniques to encourage pharmaceutical companies to act responsibly, such as subsidizing pharmaceutical research, helping to design and implement research protocols, providing a guaranteed market, and bulk buying. (shrink)

In this paper we argue that over the last 40 years the context of agronomic research in the developing world has changed significantly. Three main changes are identified: the neoliberal turn in economic and social policy and the rise to prominence of the participation and environmental agendas. These changes have opened up new spaces for contestation around the goals, priorities, methods, results and recommendations of agronomic research. We suggest that this dynamic of contestation is having important effects on (...) how agronomic research is planned, managed, implemented, evaluated and used, and is therefore worthy of detailed study. This is particularly so at a time when food security, rising food prices and the potential impacts of climate change on agriculture are in the policy spotlight. We outline a research agenda that should help illuminate the drivers, dynamics and impacts of this new ‘political agronomy’. (shrink)

Martha Nussbaum and Seyla Benhabib have raised the question of how the Western subject might engage with the non-Western other in a non-imperialistic fashion. However, both of these feminist thinkers propose a universalist framework, consistent with Donald Davidson’s conclusions regarding the translatability of ”conceptual schemes”. Drawing upon the thought of G.W.F. Hegel and Walter Benjamin, I argue that the historically constituted subject that emerges in the wake of the Enlightenment affords an account of subjectivity that recasts the meaning of rationality (...) and thus the way in which translation should be understood. I shall argue, with Benjamin, that a linguistic conceptual scheme--in short, a world—needs translation in order to remain vital, and that genuine translation not only translates the other but transforms the self who seeks to translate. (shrink)

Infertile women in the developing world face an additional layer of vulnerability compared to their counterparts in the developed world due to social, cultural, political, and socioeconomic factors that truly render their infertility a disability. After exploring how infertility in the developing world fits the World Health Organization’s biopsychosocial model of disability, we will argue that feminists and disability rights proponents should jointly articulate and advocate for change.

This article argues that advances in nanotechnology in general, and lab-on-chip technology in particular, have the potential to benefit the developing world in its quest to control risks to human health and the environment. Based on the “risk society” thesis of Ulrich Beck, it is argued that the developed world must realign its science and technology policy priorities to meet some of the most pressing needs of humanity.

How are social protections evolving in the developing world, particularly as those nations confront the challenges of globalization? Scholars in this special issue examine the challenges, continuity, and changes in social protections across the developing world over the last few decades. The common theme that emerges from this informative group of papers is that developing nations are confronting unique politico-economic difficulties as well as opportunities for the development of their welfare programs. This is a vastly (...) understudied topic. The studies in this issue tackle some of the unanswered questions of the globalization–social protection debate in developing economies, with a particular focus on how politics plays into the relationship. These articles hope to initiate a dialogue and offer suggestions for further research in this critical area of study. (shrink)

orbit and far beyond it. Indeed, the immense, painstaking, indefatigable and ever-improving effort of Husserl to find ever-deeper and more reliable foundations for the philosophical enterprise (as well as his constant critical re-thinking and perfecting of the approach and so called "method" in order to perform this task and thus cover in this source-excavation an ever more far-reaching groundwork) stands out and maintains itself as an inepuisable reservoir for philosophical reflec tion in which all the above-mentioned work has either its (...) core or its source. In fact, in his undertaking to re-think the entire philosophical enterprise as such and to recreate philosophy upon what he sought to be at least a satisfactorily legitimated basis, Husserl, through his already systematised and "authorized" work, and his courses, and later on in his spontaneous reflection (which did not find its way into a definitive corpus but was nevertheless sufficiently coherent with his previously established body of thought to be considered a continuation of it), uncovers perspectives upon the universe of man and projects their new philosophical thematisation that brings together all the attempts by philosophers (e. g., Merleau-Ponty, who drew upon this material and found there his own inspiration) who succeeded him with foundational intentions; it also gives a core of philosophical ideas and insights for the youngergenerationofphilosophers today. (shrink)

ABSTRACT This paper reports on a multidisciplinary meeting held to discuss ethical issues in medical research in the developing world. Many studies, including clinical trials, are conducted in developing countries with a high burden of disease. Conditions under which this research is conducted vary because of differences in culture, public health, political, legal and social contexts specific to these countries. Research practices, including standards of care for participants, may vary as a result. It is therefore not surprising (...) that ethical issues emerge. This meeting sought to identify and discuss these issues from the perspectives of the many actors in such research, including community representatives, with a view to finding ethical and pragmatic solutions to these issues. Dialogue between these actors was also promoted, with a view to identifying the need to develop such dialogue in future. Drawing from the experiences of the speakers, the colloquium attempted to outline some answers to several key questions characterising the field today. Experiences related to epidemiologic research, vaccine trials, drug trials, diagnostic tests and to some fundamental ethical issues in health research. Speakers were from different countries, disciplines and professions. The meeting provided a forum for consultation and debate between different ethics actors. Both encouraging findings and challenges emerged. (shrink)

This paper examines the moral force of exploitation in developing world research agreements. Taking for granted that some clinical research which is conducted in the developing world but funded by developed world sponsors is exploitative, it asks whether a third party would be morally justified in enforcing limits on research agreements in order to ensure more fair and less exploitative outcomes. This question is particularly relevant when such exploitative transactions are entered into voluntarily by all (...) relevant parties, and both research sponsors and host communities benefit from the resulting agreements. I show that defenders of the claim that exploitation ought to be permitted rely on a mischaracterization of certain forms of interference as unjustly paternalistic and two dubious empirical assumptions about the results of regulation. The view I put forward is that by evaluating a system of constraints on international research agreements, rather than individual transaction-level interference, we can better assess the alternatives to permitting exploitative research agreements. (shrink)

Increasingly, US-sponsored research is carried out in developing countries, but how US Institutional Review Boards (IRBs) approach the challenges they then face is unclear.METHODS: I conducted in-depth interviews of about 2 hours each, with 46 IRB chairs, directors, administrators and members. I contacted the leadership of 60 IRBs in the United States (US) (every fourth one in the list of the top 240 institutions by National Institutes of Health (NIH) funding), and interviewed IRB leaders from 34 (55%).RESULTS: US IRBs (...) face ethical and logistical challenges in interpreting and applying principles and regulations in developing countries, given economic and health disparities, and limited contextual knowledge. These IRBs perceive wide variations in developing world IRBs/RECs' quality, resources and training; and health systems in some countries may have long-standing practices of corruption. These US IRBs often know little of local contexts, regulations and standards of care, and struggle with understandings of other cultures' differing views of autonomy, and risks and benefits of daily life. US IRBs thus face difficult decisions, including how to interpret principles, how much to pay subjects and how much sustainability to require from researchers. IRB responses and solutions include trying to maintain higher standards for developing world research, obtain cultural expertise, build IRB infrastructure abroad, communicate with foreign IRBs, and ‘negotiate’ for maximum benefits for participants and fearing ‘worst-case scenarios’.CONCLUSIONS: US and foreign IRBs confront a series of tensions and dilemmas in reviewing developing world research. These data have important implications for increased education of IRBs/RECs and researchers in the US and abroad, and for research and practice. (shrink)

ABSTRACTRelatively little has been written about the ethics of conducting early phase clinical trials involving subjects from the developing world. Below, I analyze ethical issues surrounding one of gene transfer’s most widely praised studies conducted to date: in this study, Italian investigators recruited two subjects from the developing world who were ineligible for standard of care because of economic considerations. Though the study seems to have rendered a cure in these two subjects, it does not appear (...) to have complied with various international guidelines that require that clinical trials conducted in the developing world be responsive to their populations’ health needs. Nevertheless, policies devised to address large scale, late stage trials, such as the AZT short‐course placebo trials, map somewhat awkwardly to early phase studies. I argue that interest in conducting translational research in the developing world, particularly in the context of hemophilia trials, should motivate more rigorous ethical thinking around clinical trials involving economically disadvantaged populations. (shrink)

This entry provides an overview of business responsibilities with regard to international development and human and social development in less developed nations. Areas of ethical concern have grown in variety and complexity as understanding of development has changed from such narrow economic treatment in the era following World War II to the present. This entry traces that growth and considers responsibilities of multinational business engaging directly with and subcontracting in the developing world, most notably in telecommunications, the (...) extractive industries of oil, gas and minerals, and in garment manufacture. Topical consideration is given to political entanglement, corruption, warfare, non-sustainable practices and exploitation of workers. In light of these activities and topics, candidate ethical principles for multinational activity under the present global order are suggested in the final section. (Modified pre-review draft July 2016, for Robert W. Kolb, ed. The SAGE Encyclopedia of Business Ethics and Society: 2nd edition. Sage Publications. 2017. Final version substantially changed, including candidate ethical principles section removed. Corrected copies may be obtained from the author following publication, March 2017.). (shrink)

Bribery is a complicated, multi-dimensional issue. Upon first glance, most westerners would immediately condemn it as an underhanded, unfair means of gaining an advantage in a competitive or legal situation, and so it is in virtually every case in the westernized world. However, the issue becomes much more complicated in the international context, particularly in developing nations, where giving and accepting bribes is often normal and expected. This paper serves to inform ethical decision-making in situations where the “right (...) choice” is unclear with regards to bribery, primarily for individuals performing aid work in foreign countries with corrupt officials and police officers. In such contexts, a simple offering of food, money, or a small trinket may make the difference between a person being able to accomplish meaningful, life-changing work for the local populace or having that work significantly slowed at best and being thrown out of the country, robbed, or imprisoned in worse cases. The larger scale bribery issues in international business and the laws pertaining to them are also discussed. (shrink)

In his classic article, Famine, Affluence, and Morality, pp. 229–243), Peter Singer claimed that affluent people in the developed world are morally obligated to transfer large amounts of resources to poor people in the developing world. For present purposes I will not call Singers argument into question. While people can reasonably disagree about exactly how demanding morality is with respect to duties to the desperate, there is little question in my mind that it is much more demanding (...) than common sense morality or our everyday behavior suggests. Even someone who disagrees with this might still find some interest in seeing what a demanding morality would imply for well-off residents of the rich countries of the world. I proceed in the following way. First, I survey humanitarian aid, development assistance, and intervention to protect human rights as ways of discharging duties to the desperate. I claim that we should be more cautious about such policies than is often thought. I go on to suggest two principles that should guide our actions, based on an appreciation of our roles, relationships, and the social and political context in which we find ourselves. (shrink)

Objectives: We investigated how often journal articles reporting on human HIV research in four developing world countries mention any institutional review boards (IRBs) or research ethics committees (RECs), and what factors are involved.Methods: We examined all such articles published in 2007 from India, Nigeria, Thailand and Uganda, and coded these for several ethical and other characteristics.Results: Of 221 articles meeting inclusion criteria, 32.1% did not mention IRB approval. Mention of IRB approval was associated with: biomedical (versus psychosocial) research (...) (P = 0.001), more sponsor-country authors (P = 0.003), sponsor-country corresponding author (P = 0.047), mention of funding (P < 0.001), particular host-country involved (P = 0.002), journals having sponsor-country editors (P < 0.001), and journal stated compliance with International Committee of Medical Journal Editors (ICMJE) guidelines (P = 0.003). Logistic regression identified 3 significant factors: mention of funding, journal having sponsor-country editors and research being biomedical.Conclusions: One-third of articles still do not mention IRB approval. Mention varied by country, and was associated with biomedical research, and more sponsor country involvement. Recently, some journals have required mention of IRB approval, but allow authors to do so in cover letters to editors, not in the article itself. Instead, these data suggest, journals should require that articles document adherence to ethical standards. (shrink)

Objectives: We investigated how often journal articles reporting on human HIV research in four developing world countries mention any institutional review boards (IRBs) or research ethics committees (RECs), and what factors are involved.Methods: We examined all such articles published in 2007 from India, Nigeria, Thailand and Uganda, and coded these for several ethical and other characteristics.Results: Of 221 articles meeting inclusion criteria, 32.1% did not mention IRB approval. Mention of IRB approval was associated with: biomedical (versus psychosocial) research (...) (P = 0.001), more sponsor‐country authors (P = 0.003), sponsor‐country corresponding author (P = 0.047), mention of funding (P < 0.001), particular host‐country involved (P = 0.002), journals having sponsor‐country editors (P < 0.001), and journal stated compliance with International Committee of Medical Journal Editors (ICMJE) guidelines (P = 0.003). Logistic regression identified 3 significant factors: mention of funding, journal having sponsor‐country editors and research being biomedical.Conclusions: One‐third of articles still do not mention IRB approval. Mention varied by country, and was associated with biomedical research, and more sponsor country involvement. Recently, some journals have required mention of IRB approval, but allow authors to do so in cover letters to editors, not in the article itself. Instead, these data suggest, journals should require that articles document adherence to ethical standards. (shrink)

Since the adoption of the WTO-TRIPS Agreement in 1994, there has been significant controversy over the impact of pharmaceutical patent protection on the access to medicines in the developing world. In addition to the market exclusivity provided by patents, the pharmaceutical industry has also sought to further extend their monopolies by advocating the need for additional ‘regulatory’ protection for new medicines, known as data exclusivity. Data exclusivity limits the use of clinical trial data that need to be submitted (...) to the regulatory authorities before a new drug can enter the market. For a specified period, generic competitors cannot apply for regulatory approval for equivalent drugs relying on the originator's data. As a consequence, data exclusivity lengthens the monopoly for the original drug, impairing the availability of generic drugs. This article illustrates how the pharmaceutical industry has convinced the US and the EU to impose data exclusivity on their trade partners, many of them developing countries. The key arguments formulated by the pharmaceutical industry in favor of adopting data exclusivity and their underlying ethical assumptions are described in this article, analyzed, and found to be unconvincing. Contrary to industry's arguments, it is unlikely that data exclusivity will promote innovation, especially in developing countries. Moreover, the industry's appeal to a property rights claim over clinical test data and the idea that data exclusivity can prevent the generic competitors from ‘free-riding’ encounters some important problems: Neither legitimize excluding all others. (shrink)

Recruiting nurses from other countries is a long-standing practice. In recent years many countries in the developed world have more frequently recruited nurses from the developing world, causing an imbalance in the health services in often already impoverished countries. Despite guidelines and promises by developed countries that the practice should cease, it has largely failed to do so. A consortium of authors from countries that have experienced significant nurse poaching consider the ethical aspects behind this continuing practice.

Scientists engaged in global health research are increasingly faced with barriers to access and use of human tissues from the developing world communities where much of their research is targeted. In part, the problem can be traced to distrust of researchers from affluent countries, given the history of 'scientific-imperialism' and 'biocolonialism' reflected in past well publicized cases of exploitation of research participants from low to middle income countries. To a considerable extent, the failure to adequately engage host communities, (...) the opacity of informed consent, and the lack of fair benefit-sharing have played a significant role in eroding trust. These ethical considerations are central to biomedical research in low to middle income countries and failure to attend to them can inadvertently contribute to exploitation and erode trust. A 'tissue trust' may be a plausible means for enabling access to human tissues for research in a manner that is responsive to the ethical challenges considered. Preventing exploitation and restoring trust while simultaneously promoting global health research calls for innovative approaches to human tissues research. A tissue trust can reduce the risk of exploitation and promote host capacity as a key benefit. (shrink)

This revised and updated edition of _Open and Distance Learning in the Developing World_ sets the expansion of distance education in the context of general educational change and explores its use for basic and non-formal education, schooling, teacher training and higher education. Engaging with a range of topics, this comprehensive overview includes new material on: non-formal education: mass-communication approaches to education about HIV/AIDS and recent literacy work in India, South Africa, and Zambia schooling: new research projects in open schooling (...) in Asia and subsaharan Africa, and interactive radio instruction in South Africa the impact of new technology and globalisation: learning delivered through the internet and mobile learning the political economy: international agencies, the role of private sector, and funding. With its critical appraisal of the facts and examination of data about effectiveness, this book provides answers to problems and poses key questions for the consideration of policy makers, educational practitioners and all professionals involved in implementing and delivering sustainable open and distance learning. (shrink)

This book provides an original perspective on a range of controversial issues in educational and social research through case studies of multi-disciplinary and mixed-method research involving children, teachers, schools and communities in Europe and the developing world. These case studies from researchers "across continents" and "across disciplines" explore a range of interesting issues, including the relevance of research approaches to very different national settings, and to the kinds of questions being asked; the barriers of language and culture between (...) researcher and researched; articulating the thinking and feelings of very young children; the challenges of dealing with "partiality" of data; issues of identity, subjectivity and reflexivity; and transferring research approaches from one national setting to the problems posed in another. (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)

ABSTRACTAn estimated 1.5 million people died in 2007 from waterborne illness. While this number is unacceptably high, it represents a 16 percent improvement over the previous three years. This paper discusses the challenges and solutions to delivering clean water in the developing world. It then discusses safe water projects for a children's dormitory in Mae Nam Khun, Thailand, and for a community in Chirundu, Zambia. Both projects were designed and implemented by the Seattle University student chapter of Engineers (...) Without Borders . These projects had technical challenges that are relatively easy to resolve in the developed world, but were particularly challenging in their contexts. This paper examines how these challenges were met through collaboration with several organizations, including the Centers for Disease Control in the United States and small businesses within the host countries. (shrink)

The removal of Beall’s blog may result in increased numbers of predatory journals and their subsequent victims. Recognizing this, the World Association of Medical Editors suggested criteria for identifying predatory journals in a statement issued on February 18, 2017. These criteria may be helpful in the current scenario of scientific publishing. However, a few lapses and limitations need to be taken into account when translating these policies to the situation in developing countries. This letter presents several cases of (...) legitimate journals and platforms from the developing world that may be erroneously categorized as predatory according to the WAME criteria. We also suggest some improvements in these journals’ policies. (shrink)

Researchers have identified how in some rapidly developing countries, road and aviation transportation CO2 emissions are rising faster (over time) when compared to the experiences of the USA at similar levels of economic development. While suggestive of how experiences of the rapidly developing Asia are different from those of the developed world these studies have used only one developed country for comparison, the USA, arguably a special case when it comes to transportation. To address this point this (...) research compares the road transportation CO2 experiences of rapidly developing Asian economies (Hong Kong, Japan, Malaysia, Singapore, South Korea, Taiwan and Thailand) with the USA and six other developed economies (Australia, France, the Netherlands, Italy, Sweden and the United Kingdom). The findings confirm previous results, to wit, Asian economies demonstrate faster annual growth of CO2 emissions in comparison to the experiences of the developed world. (shrink)

In this article, I analyse the discursive construction of adolescent pregnancy and childbearing as a development ‘problem’ in Plan’s ‘Because I’m a Girl’ campaign. I draw on existing scholarship that configures teenage pregnancy prevention campaigns in the ‘developed’ world as a site of biopolitics that seeks to maximise the well-being of the population by governing adolescent girls’ reproductive and sexual behaviours. Identifying Plan’s campaign as part of a larger turn towards adolescent girls in development discourse and policy, I also (...) draw on a growing body of scholarship that examines how campaigns targeting adolescent girls reinforce neo-liberal understandings of ‘development’ as achievable through the empowerment of individuals rather than through structural change. I argue that by discursively constructing adolescent pregnancy and parenthood as risky, Plan’s campaign reinforces reproductive norms of delayed reproduction and sexual debut, according to which adolescent girls in the ‘developing’ world are expected to comply. The campaign’s goal of ‘empowerment’ thus acts as a means of constructing adolescent girls as responsible reproductive decision makers who will break the ‘cycle of poverty’ by making rational reproductive and sexual choices. Thus, although Plan’s ‘Because I’m a Girl’ campaign addressed important issues, including adolescent girls’ right to reproductive autonomy, their focus on empowerment operates as a form of biopower that pursues the project of development through the regulation of girls’ reproduction and sexuality. (shrink)

The advent of HIV focussed broad social attention on the group of people most affected by it in Australia, the so-called ‘gay community’. However, what a gay community actually was, and what kind of rights and duties were being attached to it remained unclear. However, it is obvious that such a community — or communities — did not fit the model proposed by communitarian writers like Michael Sandel and Charles Taylor, whereby subjects cannot stand outside their own constitutive attachments. I (...) also consider the common criticism of communitarianism, and see what kinds of collectives can in fact be considered ethical.The first part of this paper looks at the ethical issues surrounding community attachment of this kind in Australia in relation to the ethics of HIV/aids clinical research. In particular I examine the way in which certain forms of gay community attachment can be used to strengthen personal autonomy and check exploitation within the prevention and research process.The second part of this paper draws upon the issues just discussed. In particular I focus on the use of ‘community’ in the research process in developing countries, and suggest ways in which cultural considerations might strengthen autonomy. However, I go on to suggest that in many cases the idea of community has served the opposite purpose, and has in fact been used to oppress certain individuals and groups within the developing world, in the so-called interests of the greater good. In order to avoid this, I suggest a model of social and ethical research whereby all subjects and researchers in the clinical process might stand in greater relationships of equality with each other. (shrink)

This paper examines the case of a recent H5N1virus (avian influenza) outbreak in West Bengal, an eastern state of India, and argues that poorly executed pandemic management may be viewed as a moral lapse. It further argues that pandemic management initiatives are intimately related to the concept of health as a social 'good' and to the moral responsibility of protection from foreseeable social harm from an infectious disease. The initiatives, therefore, have to be guided by special moral obligations towards biorisk (...) reduction, obligations which remain unfulfilled when a public body entrusted with the responsibility fails to manage satisfactorily the prevention and control of the infection. The overall conclusion is that pandemic management has a moral dimension. The gravity of the threat that fatal infectious diseases pose for public health creates special moral obligations for public bodies in pandemic situations. However, the paper views the West Bengal case as a learning opportunity, and considers the lapses cited as challenges that better, more effectively conducted pandemic management can prepare for. It is hoped that this paper will provoke constructive bioethical deliberations, particularly pertinent to the developing world, on how to ensure that the obligations towards health are fulfilled ethically and more effectively. (shrink)

CITATION: Horn, L. M. 2015. Promoting responsible research conduct in a developing world academic context. South African Journal of Bioethics and Law, 6:21-24, doi:10.7196/SAJBL.256.

The South African Choice on Termination of Pregnancy Act 92 of 1996 gives women the right to voluntary abortion on request. The reality factor, however, is that five years later there are still more ‘technically illegal’ abortions than legal ones. Amongst other factors, one of the main obstacles to access to this constitutionally enshrined human right is the right to conscientious objection/refusal. Although the right to conscientious objection is also a basic human right, the case of refusal to provide abortion (...) services on conscientious objection grounds should not be seen as absolute and inalienable, at least in the developing world. In the developed world, where referral to another service provider is for the most part accessible, a conscientious objector to abortion does not really put the abortion seeker’s life at risk. The same cannot be said in developing countries even when abortion is decriminalised. This is because referral procedures are fraught with major obstacles. Therefore, it is argued that the right to conscientious objection to abortion should be limited by the circumstances in which the request for abortion arises. (shrink)

In the context of clinical and non-clinical biomedical practices, negligence is usually understood as a lapse of a specific professional duty by a healthcare worker or by a medical facility. This paper tries to delineate systemic negligence as another kind of negligence in the context of health systems, particularly in developing countries, that needs to be recognized and addressed. Systemic negligence is not just a mere collection of stray incidences of medical errors and system failures in a health system, (...) but is proposed in this paper as a more pervasive kind of neglect. Several non-medical factors, such as lack of social and political will, also contribute to it and hence is more difficult to address in a health system. This paper argues that recognizing systemic negligence and including it research agenda have special moral importance for researchers in developing world bioethics, public health ethics and for health activists in the developing world. For, it can be a potent health system barrier, and can seriously impair efforts to ensure patient safety, particularly in the weaker health systems. As it erodes accountability in a health system, addressing it is also important for the twin goals of ensuring patient safety and improving health system performance. Above all, it needs to be addressed because the tolerance of its persistence in a health system seems to undervalue health as a social good. (shrink)

Researchers appear to take unfair advantage of those who live in the developing world by using placebo-controlled trials to test the efficacy of drugs. This type of trial would not be permitted in developed countries, since in these countries treatment is available for the conditions that the drugs aim to treat. But if researchers are required to conduct active-controlled trials, the cost of doing research would increase, making research in developing countries inefficient and robbing these countries of (...) the benefits of participation. Contributors to Exploitation and Developing Countries, edited by Jennifer S. Hawkins and Ezekiel J. Emanuel, try to balance these concerns. (shrink)

It is often argued that multinational companies and other foreign developers have a responsibility to improve the material conditions of the people in whose territories they operate. As a matter of distributive justice it is thought that these companies should be sharing the acquired wealth with these people through the creation of ‘collective goods’ , infrastructure development and compensation disbursements aimed at their benefit. Recently “stakeholder theory” and even legislative changes in the first world have sought to impress on (...) the corporate world the necessity to share the profits with affected “non‐shareholder” groups. Many see these developments as possible advancements for indigenous peoples, indigenous rights and the cause of distributive justice for aboriginal groups. However, it can be shown that the attribution of such ‘imperfect’ duties to corporations results in the generation of excessive costs and of unrealistic expectations on the part of stakeholders. Distributive justice is more efficiently achieved by public sector involvement at the level of policy and project management. (shrink)

ABSTRACTThe principle of informed refusal poses a specific problem when it is invoked by a pregnant woman who, in spite of having accepted her pregnancy, refuses the diagnostic and/or therapeutic measures that would ensure the well‐being of her endangered fetus. Guidelines issued by professional bodies in the developed world are conflicting: either they allow autonomy and informed consent to be overruled to the benefit of the fetus, or they recommend the full respect of these principles. A number of medical (...) ethicists advocate the overruling of alleged irrational or unreasonable refusal for the benefit of the fetus. The present essay supports the view of fetal rights to health and to life based on the principle that an ‘accepted’ fetus is a ‘third person’. In developing countries, however, the implementation of the latter principle is likely to be in conflict with a ‘communitarian’ perception of the individual – in this case, the pregnant woman. Within the scope of the limitations to the right to autonomy of J.S. Mill's ‘harm principle’, the South African Patients’ Charter makes provision for informed refusal. The fact that, in practice, it is not implemented illustrates the well‐known difficulty of applying Western bioethical principles in real life in the developing world. (shrink)

This paper builds on previous research about the potential downsides of food sovereignty activism in relatively wealthy societies by developing a three-part taxonomy of harms that may arise in such contexts. These are direct opposition, false equivalence, and diluted goals and methods. While this paper provides reasons to resist complacency about wealthy-world food sovereignty, we are optimistic about the potential for food sovereignty in wealthy societies, and we conclude by describing how wealthy-world food sovereignty can be a (...) location of either transnational solidarity or nonharmful forms of cooptation. (shrink)

ABSTRACT In recent years there has been intense debate regarding the level of medical care provided to ‘standard care’ control groups in clinical trials in developing countries, particularly when the research sponsors come from wealthier countries. The debate revolves around the issue of how to define a standard of medical care in a country in which many people are not receiving the best methods of medical care available in other settings. In this paper, we argue that additional dimensions of (...) the standard of care have been hitherto neglected, namely, the structure and efficiency of the national health system. The health system affects locally available medical care in two important ways: first, the system may be structured to provide different levels of care at different sites with referral mechanisms to direct patients to the appropriate level of care. Second, inefficiencies in this system may influence what care is available in a particular locale. As a result of these two factors locally available care cannot be equated with a national ‘standard’. A reasonable approach is to define the national standard of care as the level of care that ought to be delivered under conditions of appropriate and efficient referral in a national system. This standard is the minimum level of care that ought to be provided to a control group. There may be additional moral arguments for higher levels of care in some circumstances. This health system analysis may be helpful to researchers and ethics committees in designing and reviewing research involving standard care control groups in developing country research. (shrink)

The 2012 Varsity Medical Debate between Oxford University and Cambridge University provided a stage for representatives from these famous institutions to debate the motion “This house believes that trainee doctors should be able to use the developing world to gain clinical experience.” This article brings together many of the arguments put forward during the debate, centring around three major points of contention: the potential intrinsic wrong of ‘using’ patients in developing countries; the effects on the elective participant; (...) and the effects on the host community. The article goes on to critically appraise overseas elective programmes, offering a number of solutions that would help optimise their effectiveness in the developing world. (shrink)