For a Few Benefits More: <br>Justice in International Research

For a Few Benefits More:
Justice in International Research

After long taking a backseat to Beneficence, Non-maleficence and Autonomy, the concept of Justice is experiencing a renaissance in bioethics, particularly in international research ethics. All too often in the past, international biomedical research has placed most of burdens of research on participants and communities in the developing world, while developed world has reaped most of the benefits. There is general agreement that this imbalance of benefits and burdens constitutes exploitation.

But beyond that, there are fundamental disagreements among bioethicists about what the pursuit of justice in international research involves. There currently seem to be two opposing camps forming. Let us call them the minimalist and the aspirational.

According to the minimalist camp, justice in research consists in the avoidance of exploitation, and avoiding exploitation involves a negotiation of a fair benefits/burden ratio between research host communities and research institutions. As long as the research does not make the host community worse off, provides the community with some benefits, and the community judges those benefits of research to compensate for the burdens, then such research is non-exploitative, i.e. just.

It is fair to say that the minimalist view is dominant in international research ethics. After the 2001 Conference on Ethical Aspects of Research in Developing Countries, the delegates – including some big names from big institutions -- formulated a ‘Fair Benefits’ framework of justice in research. The document gives a somewhat quaint view of international research, where creative bargains about all sorts of benefits are cheerfully struck between host communities and research institutions. Imagine the conversations: “No, sorry, we cannot give you this drug if the trial is successful. But how about 5 boreholes for clean water?” As long as the host community comes away from the negotiating table with ~~crumbs~~ whatever benefits are on offer, justice is served. More recent reports, such as the Nuffield Council on Bioethics latest contribution don’t depart from the trend.

Another, more ‘aspirational’ camp is emerging. In this month’s Hasting Center Report, Alex John London takes the minimalist view to task for assuming that the social, political and health care status quo in developing countries is the ‘moral baseline’ from which to evaluate justice in international research. In essence, he asks whether not making impoverished communities worse off is anything (ethically) to write home about, and whether providing the destitute with a bit of ~~borehole~~ benefit meets the obligations of a worthwhile concept of justice. Real justice in international research involves more: to see how much more, well, it won’t be fair to summarize. Read it yourself: (Subscription Required). - Stuart Rennie

posted Apr 8, 2005 | link | jump to the comments (7)

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You can access the subscription-only journal by clicking
on "sample issue" at the left (in blue, under the figure) at
http://muse.jhu.edu/journals/hastings_center_report/

- by Beverly on Apr 9, 2005 at 12:01 PM | link

I think Alex Londond is certainly right about the "minimalist" view of justice in international research being indadequate. But why not just (re)turn to Rawls' -- and argue that a just/fair benefits/burdens ratio requires that the gap between the haves and havenots be narrowed? From that perspective, it should be obvious that a great deal more than a few boreholes for the host community is needed to "more than compensate" for the benefits that accrue to the sponsoring community. In other words, we need to "mind the gap" -- with a view to narrowing it.

- by Bob Koepp on Apr 9, 2005 at 12:06 PM | link

Thanks Beverly for redirecting traffic.
Thanks Bob for your comment. I am mostly in agreement with you, I think, but if you are suggesting that London is just replaying Rawls, or that he should turn to Rawls, I'm not convinced. I am not at all a Rawls scholar, but let me venture a few words.
I think London is going further than Rawls himself would be comfortable with. For one thing, Rawls was reluctant to apply his views about distributive justice (in A Theory of Justice) on an international level. When Rawls did deal with international relations (in Law of Peoples), he held onto a strong conception of state sovereignty, which allows for countries to be dirt poor, corrupt and full of inequality, as long as they are not marked by outright famine, genocide or outright oppression (i.e. are 'minimally decent'). Even his former students (like Thomas Pogge) thinks the 'law of peoples' does not repond well to present global realities.
Another difference is that London brings in history and responsibility in talking about the gap between have and have nots. The small problems about benefit in research are symptomatic of bigger problems of global justice, i.e. from a 'global basic structure' (the term is from Pogge) which is itself fundamentally unjust, and which contributes to poor health in 'low-income' countries. London is partly arguing that international researchers are part of a system of legal, economic and political relations (from colonial times onward) largely responsible for the poverty and poor health in the developing world. It's the 'pottery barn' argument: if you broke it, you pay. Rawls did not make much use causal/ethical responsibility arguments when talking about justice, to my knowledge.

- by Stuart on Apr 10, 2005 at 3:51 AM | link

Law of Peoples is not particularly relevant here. Research ethics isn't, in the first instance, about relations between sovereign states, though that can easily become a complicating factor. Nor is there anything "internal" to Rawls' account of distributive justice which would prevent its being applied globally. Indeed, since that theory of distributive justice is fashioned as a "universal" theory, I see no reason not to apply it globally.
My only point was that the minimalist view criticized by London falls far short of what is required in light of the most influential theory of distributive justice on the scene. One needn't appeal to much more controversial views about compensatory justice to undermine the minimalist view that requires only a positive benefits/burdens ratio, since it is easy to demonstrate that a positive b/b ratio is compatible with _increasing_ disparities between the haves and have nots. So let's get research ethics to move forward at least as far as justice as fairness can take us, even if we haven't yet settled questions about how to compensate for past injustices.

- by Bob Koepp on Apr 10, 2005 at 12:17 PM | link

Bob,
I agree with your points, though I am personally not entirely comfortable of leaving compensatory justice to one side while talking about justice as fairness. When people ask 'why should any sacrifices be made by my society for low-income countries?', the answer should not just be 'Because that is what you rationally should do from the Original Position.' True, that might be enough to send the minimalist view packing. But ultimately I would want to bring on the historical/political perspective into the justice debate, controversy or not.
Your phrase that a 'positive b/b ratio is compatible with increasing disparities' is great.
As someone doing bioethics and research in the Democratic Republic of Congo, I find it fascinating to think about what using a more substantive concept of justice in research would come down to in practical terms. London is not specific, so there is lots of room for exploration.

- by Stuart on Apr 10, 2005 at 4:33 PM | link

Stuart-
I'd only advocate "setting aside" issues of compensatory justice to the extent that I don't want the ensuing controversy to provide an excuse for not getting on with what should be a lot more agreeable -- that justice requires good faith efforts to "narrow the gap." I have no doubt that such efforts will require careful attention to the causes of inequality. And we can take actions to remove those causes of inequality right now, even if we can't (yet) agree about whether, or what kind of compensation is owed by those who created or benefited from the conditions in question.