How international research might contribute to justice in global health has not been substantively addressed by bioethics. Theories of justice from political philosophy establish obligations for parties from high-income countries owed to parties from low and middle-income countries. We have developed a new framework that is based on Jennifer Ruger's health capability paradigm to strengthen the link between international clinical research and justice in global health. The ‘research for health justice’ framework provides direction on three aspects of international clinical research: (...) the research target, research capacity strengthening, and post-trial benefits. It identifies the obligations of justice owed by national governments, research funders, research sponsors, and investigators to trial participants and host communities. These obligations vary from those currently articulated in international research ethics guidelines. Ethical requirements of a different kind are needed if international clinical research is to advance global health equity. (shrink)

How international research might contribute to justice in global health has not been substantively addressed by bioethics. Theories of justice from political philosophy establish obligations for parties from high‐income countries owed to parties from low and middle‐income countries. We have developed a new framework that is based on Jennifer Ruger's health capability paradigm to strengthen the link between international clinical research and justice in global health. The ‘research for health justice’ framework provides direction on three aspects of international clinical research: (...) the research target, research capacity strengthening, and post‐trial benefits. It identifies the obligations of justice owed by national governments, research funders, research sponsors, and investigators to trial participants and host communities. These obligations vary from those currently articulated in international research ethics guidelines. Ethical requirements of a different kind are needed if international clinical research is to advance global health equity. (shrink)

The idea that payment for research participation can be coercive appears widespread among research ethics committee members, researchers, and regulatory bodies. Yet analysis of the concept of coercion by philosophers and bioethicists has mostly concluded that payment does not coerce, because coercion necessarily involves threats, not offers. In this article we aim to resolve this disagreement by distinguishing between two distinct but overlapping concepts of coercion. Consent-undermining coercion marks out certain actions as impermissible and certain agreements as unenforceable. By contrast, (...) coercion as subjection indicates a way in which someone’s interests can be partially set back in virtue of being subject to another’s foreign will. While offers of payment do not normally constitute consent-undermining coercion, they do sometimes constitute coercion as subjection. We offer an analysis of coercion as subjection and propose three possible practical responses to worries about the coerciveness of payment. (shrink)

A growing literature documents the existence of individuals who make a living by participating in phase I clinical trials for money. Several scholars have noted that the concerns about risks, consent, and exploitation raised by this phenomenon apply to many (other) jobs, too, and therefore proposed improving subject protections by regulating phase I trial participation as work. This article contributes to the debate over this proposal by exploring a largely neglected worry. Unlike most (other) workers, subjects are not paid to (...) produce or achieve anything but to have things done to them. I argue that this passivity is problematic for reasons of distributive justice. Specifically, it fails to enable subjects to realize what Gheaus and Herzog call “the goods of work”—a failure not offset by adequate opportunities to realize these goods outside of the research context. I also consider whether granting subjects worker-type protections would accommodate this concern. (shrink)

This essay differentiates two approaches to understanding the concept of coercion, and argues for the relative merits of the one currently out of fashion. The approach currently dominant in the philosophical literature treats threats as essential to coercion, and understands coercion in terms of the way threats alter the costs and benefits of an agent’s actions; I call this the “pressure” approach. It has largely superseded the “enforcement approach,” which focuses on the powers and actions of the coercer rather than (...) the perspective of the coercee. The enforcement approach identifies coercion with certain uses of the kinds of powers that agents need to accumulate and wield in order to be able to make significant, credible threats. Though there is considerable overlap extensionally in the instances of coercion recognized by the two approaches, the enforcement approach encompasses some uses of power to coerce that do not involve threats . It also circumscribes which threats should be counted as coercive, though notably it provides a picture of coercion that is non-moralized in its essentials. While there may be specific purposes for which a pressure account is to be preferred, I argue that the enforcement approach better describes how coercion works, and elucidates factors that are often tacitly assumed by pressure accounts. It also is more useful for explaining the social and political significance of coercion, and why coercion is thought to have the implications commonly associated with it. In particular, I argue that it helps us understand why uses of coercion are in general a matter of ethical significance, why state authority depends on commanding a monopoly on the right to use coercion, and why being coerced may reasonably provide one a defense against being held responsible for actions one is coerced into taking. (shrink)

Recent accounts of coercion can be mapped onto two different axes: whether they focus on the situation of the coercee or the activities of the coercer; and whether or not they depend upon moral judgments in their analysis of coercion. Using this analysis, I suggest that almost no recent theories have seriously explored a non-moralized, coercer-focused approach to coercion. I offer some reasons to think that a theory in this underexplored quadrant offers some important advantages over theories confined to the (...) other quadrants. In particular I suggest that much of our interest in coercion depends on facts about the coercer, such as the sorts of powers coercers must possess to be able to coerce, and on the coercer's intention in using those powers to constrain or alter the coercee's activities. (shrink)

This volume breaks new ground by investigating the ethics of vulnerability. Drawing on various ethical traditions, the contributors explore the nature of vulnerability, the responsibilities owed to the vulnerable, and by whom.