The paper defends the permissibility of paying inducements to research subjects against objections not covered in an earlier paper in Bioethics. The objections are that inducements would cause inequity, crowd out research, and undesirably commercialize the researcher‐subject relationship. The paper shows how these objections presuppose implausible factual and/or normative claims. The final position reached is a qualified defence of freedom of contract which not only supports the permissibility of inducements but also offers guidance to ethics committees in dealing with practical (...) problems that might arise if inducements are offered. (shrink)

Opposition to inducement payments for research subjects is an international orthodoxy amongst writers of ethics committee guidelines. We offer an argument in favour of these payments. We also critically evaluate the best arguments we can find or devise against such payments, and except in one very limited range of circumstances, we find these unconvincing.

Payment for research participation has raised ethical concerns, especially with respect to its potential for coercion. We argue that characterising payment for research participation as coercive is misguided, because offers of benefit cannot constitute coercion. In this article we analyse the concept of coercion, refute mistaken conceptions of coercion and explain why the offer of payment for research participation is never coercive but in some cases may produce undue inducement.

In this book, Alan Wertheimer seeks to identify when a transaction or relationship can be properly regarded as exploitative--and not oppressive, manipulative, or morally deficient in some other way--and explores the moral weight of taking ...

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We should try to alleviate it through allowing a current market in them continues to be morally condemned, usually on the grounds tha.

Offering cash payments to research subjects is a common recruiting method but there is significant debate about whether and in what amount such payments are appropriate. This paper is concerned with exploitation and whether there should be a lower limit on the amount researchers can pay their subjects. When subjects participate in research as a way to make money, fairness requires that researchers pay them a fair wage. This call for the establishment of a lower limit meets resistance in two (...) places: (1) denial that the payments offered by researchers are wages for participation; and (2) concern about undue inducement. This paper critically examines these arguments for and against a lower limit. It shows that the need for a lower limit cannot be avoided by adopting a non-wage payment model and that concerns about undue inducement are unjustified in all trials except those that present greater than minimal risk. This analysis suggests the following compromise position: there should be an unconditional lower limit on payment amounts so that researchers cannot offer less than a fair wage, and when researchers cannot satisfy this limit because fairness requires a problematically large payment, then researchers should offer no payment at all. (shrink)

Randomised controlled trials (RCTs) sometimes recruit participants who are desperate to receive the experimental treatment. This paper defends the practice against three arguements that suggest it is unethical first, desperate volunteers are not in equipoise. Second clinicians, entering patients onto trials are disavowing their therapeutic obligation to deliver the best treatment; they are following trial protocols rather than delivering individualised care. Research is not treatment; its ethical justification is different. Consent is crucial. Third, desperate volunteers do not give proper consent: (...) effectively, they are coerced. This paper responds by advocating a notion of equipoise based on expert knowledge and widely shared values. Where such collective, expert equipoise exists there is a prima facie case for an RCT. Next the paper argues that trial entry does not involve clinicians disavowing their therapeutic obligation; individualised care based on insufficient evidence is not in patients best interest. Finally, it argues that where equipoise exists it is acceptable to limit access to experimental agents; desperate volunteers are not coerced because their desperation does not translate into a right to receive what they desire. (shrink)

This paper argues against paying people to participate in research. Volunteering to participate as a subject in a research program is not like taking a job. The main difference is to do with the risks inherent in research. Experimentation on human beings is, by definition, trying out something with an unknown consequence and exposes people to risks of harm which cannot be known in advance. This is the main reason for independent review by committee of research programs. It is based (...) on a recognition that researchers are not always capable of putting the interests of their subjects ahead of their research objectives. It is not simply a matter of individual autonomy. Society has an obligation, prior to the protection of individual freedom and autonomy, to establish basic safeguards that are equitable in their operation. Any inducement for participating in research would add to the difficulty subjects have in adequately assessing the risks of participating in research. An acceptance of inducement to participate in research would further increase the inequity of research conducted on the impecunious for the benefit of the well‐off. (shrink)

Does the “free market” foster more freedom for individuals generally and less coercion? Libertarians and other market advocates argue that the unfettered market maximizes freedom and hence has less coercion than any feasible alternative. Welfare liberals, Socialist, and Marxists, in different ways, argue against the claim that the unrestricted market maximizes freedom generally. Both supporters and critics agree that coercion undermines freedom and that that is what is ultimately prima facie wrong with it. Further, they agree that the extent to (...) which an economic system includes coercion provides a serious strike against it. The problem is that there is little consensus on the necessary conditions for coercion. In this paper I will be concerned with the nature of coercive relationships in the market. Market interactions have a particular character and occur within a specific institutional framework. Other accounts of coercion have failed to capture the unique character of coercion in the market because they have failed to take into account certain nontrivial facts about the market which are essential to the analysis of coercive market relations. (shrink)

Does the “free market” foster more freedom for individuals generally and less coercion? Libertarians and other market advocates argue that the unfettered market maximizes freedom and hence has less coercion than any feasible alternative. Welfare liberals, Socialist, and Marxists, in different ways, argue against the claim that the unrestricted market maximizes freedom generally. Both supporters and critics agree that coercion undermines freedom and that that is what is ultimately prima facie wrong with it. Further, they agree that the extent to (...) which an economic system includes coercion provides a serious strike against it. The problem is that there is little consensus on the necessary conditions for coercion. In this paper I will be concerned with the nature of coercive relationships in the market. Market interactions have a particular character and occur within a specific institutional framework. Other accounts of coercion have failed to capture the unique character of coercion in the market because they have failed to take into account certain nontrivial facts about the market which are essential to the analysis of coercive market relations. (shrink)

This paper offers a new answer to an old question. Others have argued that exploitation is wrong because it is coercive, or degrading, or fails to protect the vulnerable. But these answers only work for certain cases; counterexamples are easily found. In this paper I identify a different answer to the question by placing exploitation within the larger family of wrongs to which it belongs. Exploitation is one species of wrongful gain, and exploiters always gain at the expense of others (...) by inflicting relative losses on disadvantaged parties. They do harm to their victims, even when their interactions are mutually advantageous, by failing to benefit the disadvantaged party as fairness requires. This failure is the essential wrong in every case of wrongful exploitation. At the end of the paper I assess how wrong this failure is as a way to gain at another's expense. (shrink)

In many cases, claims that a transaction is exploitative will focus on the details of the transaction, such as the price paid or conditions. For example, in a claim that a worker is exploited, the grounds for the claim are usually that the pay is not sufficient or the working conditions too dangerous. In some cases, however, the claim that a transaction is exploitative is not seen to rely on these finer details. Many, for example, claim that organ sales would (...) be exploitative, in a way that doesn't seem to depend on the details. This article considers, but ultimately rejects, a number of arguments which could be used to defend this sort of claim. (shrink)

(2001). Is Informed Consent Enough? Monetary Incentives for Research Participation and the Integrity of Biomedicine. The American Journal of Bioethics: Vol. 1, No. 2, pp. 49-51.

We would not be far wide of the mark if we suggested that the prevailing social ideology is structured round the presumption that interpersonal and political relationships ought to be, and for the most part are, based on the mutual consent of the parties involved. Liberal democratic theory has secured for consent a crucial role in the justification of political obligation and authority. In law, the maximvolenti non fit injuria,to the one who consents no wrong is done, constitutes a defence (...) in cases where one person invades the interests of another. In the bioethical field, there is a preoccupation with the formulation of a standard of ‘informed consent’ in patient-doctor and subject-researcher relationships. And in the broader domain of ethical theory there is an influential view that consensual acts do not differ in moral quality from selfregarding behaviour. (shrink)

Almost all ethical guidelines and legislative policies concerning biomedical research involving human subjects contain provisions about relevance of research for the participating populations, informed consent, adequate care for research induced injuries and several other safeguards but the poor continue to suffer. Globalization has further aggravated poor people’s vulnerability by exposing them to international markets. Since the developing countries are abode of higher population of the poor they have become the unholy mines of this human ore for researchers. In this paper (...) I examine various dimensions of poverty and analyze the international ethical responses in the area of biomedical research involving human subjects in order to determine their adequacy to protect the poor against exploitation and misuse and conclude that in view of the poor’s inherent and extreme vulnerability and the failure of ethical pronouncements to protect them from misuse and exploitation, they should be excluded from being enrolled as research subjects. (shrink)

Despite its title, Alan Wertheimer’s new book is not another tiresome exploration of Marxist economic theories. Indeed, there is virtually no extended discussion of Marxism at all, since Wertheimer believes that what is unique to that perspective is highly problematic, given that when Marxists simply assert that capitalists do exploit wage laborers they are appealing to “the ordinary notion that one party exploits another when it gets unfair and undeserved benefits from its transactions or relationships with others”. His goal is (...) to analyze this ordinary sense of exploitation, to explore in detail some of the many forms it can take, and to begin some serious thinking about what he terms its moral weight and its moral force. This groundbreaking work, the first book-length treatment of its subject from a broadly analytic standpoint, should do much to disabuse non-Marxist philosophers of the notion that exploitation is largely peripheral to the central questions of moral and political philosophy. (shrink)

Bioethical arguments conceal the coercion underlying the choice between poverty and selling ones organsIn mid-May 2006, three Palestinian prisoners detained in Israel applied to the Israeli Prison Service for permission to sell their kidneys in order to send money to their children for food. Whether truly sincere or merely propagandistic, the request was made against the background of Israel’s decision to suspend the transfer of Palestinian tax moneys to the Hamas-led Palestinian Authority, and the subsequent increasing poverty and famine in (...) the Gaza Strip.1An official decision was yet to be made when this paper was written. However, the IPS chief medical officer had already made it clear that the request is likely to be rejected. Aside from emphasising that the cost of the pertinent treatment of the prisoners could not be imposed on the IPS, especially as it would greatly exceed the sum to be obtained by the sellers , he asserted that the IPS “won’t lend a hand to endangering the prisoner”. He also reiterated the official IPS policy, according to which the prisoners’ consent to such transaction could not be valid, since they might have been threatened by people from inside or outside the prison.1This is ironic. While the IPS’ professed concerns for the welfare and best interests of the prisoners are commendable, they conceal and hence reaffirm the real coercion implicit in the dilemma the prisoners face: to sell their kidney or let their children starve. Interestingly, approval of their request would have equally concealed the coercion, this time behind concerns for either their autonomy, or the welfare of their children, or both.At present, it is unlikely that Israel will acknowledge the role of national oppression and poverty in producing this dilemma. Rather, the debate will remain focused on …. (shrink)

In American legal journals over the last decade there were hundreds of pages of articles worrying over threats to justice and freedom arising from the power to withhold benefits. Government officials have tremendous discretion to offer or withhold foreign aid, ration-books, government contracts and jobs, welfare subsidies, public housing, tariff protection, academic grants, alien resident status, paroles, or exemption from conscription or combat, from arrest or prosecution or imprisonment. Right-wing economists have worried about welfare-state emphasis on administrative discretion rather than (...) the rule of law. And left-wing economists have worried about the rich man's power to intimidate the poor man by threatening to cut off his productive work. (shrink)

It is commonly thought that transactions that are the result of voluntary gift-giving do not constitute exploitation. This article argues that exploitation is indeed possible in such situations, by showing how gift-giving can fulfil the two commonly proposed criteria for exploitation, namely that in an interaction between two persons one receives disproportionally little and the other disproportionally much of the resulting net benefits, and that this disproportion is caused by the latter making inappropriate use of a disadvantage of the former. (...) Firstly, it is shown that it is reasonable to consider the outcome of gift-giving disproportional. Secondly, it is noted that some but not all descriptions of inappropriate use of a disadvantage are compatible with exploitation of giftgiving. However, a theoretical approach to what this criterion would amount to in cases of gift-giving is lacking. It is therefore the aim of the second part of the article to spell out conditions of relevance for exploitation of gift-giving as a first step towards constructing a theoretical framework for exploitation of gift-giving, enabling us to detect when gift-giving is exploited. The method of reflective equilibrium inspires this explorative analysis, which proceeds by testing intuitions about examples that embody a set of possible conditions. All but one of these conditions have been retrieved from the general literature on exploitation. It is concluded that three of the conditions are necessary for exploitation of gift-giving, namely that the giver incurs a loss, the recipient has aimed for the gift, and the gift is undeserved. (shrink)

Women as commercial baby factories, nature as an economic resource, life as one big shopping mall: This is what we get when we use the market as a common ...

This is the third volume of Joel Feinberg's highly regarded The Moral Limits of the Criminal Law, a four-volume series in which Feinberg skillfully addresses a complex question: What kinds of conduct may the state make criminal without infringing on the moral autonomy of individual citizens? In Harm to Self, Feinberg offers insightful commentary into various notions attached to self-inflicted harm, covering such topics as legal paternalism, personal sovereignty and its boundaries, voluntariness and assumptions of risk, consent and its counterfeits, (...) coercive force, incapacity, and choice of death. (shrink)

_Bodies for Sale: Ethics and Exploitation in the Human Body Trade _explores the philosophical and practical issues raised by activities such as surrogacy and organ trafficking. Stephen Wilkinson asks what is it that makes some commercial uses of the body controversial, whether the arguments against commercial exploitation stand up, and whether legislation outlawing such practices is really justified. In Part One Wilkinson explains and analyses some of the notoriously slippery concepts used in the body commodification debate, including exploitation, harm and (...) consent. In Part Two he focuses on three controversial issues outlining contemporary regulation and investigating both the moral issues and the arguments for legal prohibition. (shrink)

This 1988 volume is a collection of thirteen seminal essays on ethics, free will, and the philosophy of mind. The essays deal with such central topics as freedom of the will, moral responsibility, the concept of a person, the structure of the will, the nature of action, the constitution of the self, and the theory of personal ideals. By focusing on the distinctive nature of human freedom, Professor Frankfurt is able to explore fundamental problems of what it is to be (...) a person and of what one should care about in life. (shrink)