Abstract

Recent discussion on the need to reassess research ethics standards has called into question familiar concepts such as equipoise, coercion, undue inducement, and the protection of vulnerable subjects. Reassessment of these concepts can be useful for a variety of reasons. It can eliminate conceptual murkiness, can assist in the proposal of regulations to better protect human subjects, and can elucidate ethical concerns. In this essay, I call attention here to a different, and often neglected, reason why reassessment of research ethics concepts can be helpful. It can undermine the all-too-common practice of taking as a given the social and political conditions in which biomedical research takes place and can encourage the inclusion of broader questions about social justice, human flourishing, or about the importance of taking into account the social determinants of health and disease. I will focus on some recent attempts to reevaluate the concept of vulnerability in research ethics. I will argue that such attempts, by calling attention to the characteristics that can render participants vulnerable, can promote, rather than discourage, moral reflection about social and global justice concerns among bioethicists, policy makers, investigators, and members of Institutional Review Boards.