: The debate over when medical research may be performed in developing countries has steered clear of the broad issues of social justice in favor of what seem more tractable, practical issues. A better approach will reframe the question of justice in international research in a way that makes explicit the links between medical research, the social determinants of health, and global justice.

The debate over when medical research may be performed in developing countries has steered clear of the broad issues of social justice in favor of what seem more tractable, practical issues. A better approach will reframe the question of justice in international research in a way that makes explicit the links between medical research, the social determinants of health, and global justice.

The most widely debated conception of democracy in recent years is deliberative democracy--the idea that citizens or their representatives owe each other mutually acceptable reasons for the laws they enact. Two prominent voices in the ongoing discussion are Amy Gutmann and Dennis Thompson. In Why Deliberative Democracy?, they move the debate forward beyond their influential book, Democracy and Disagreement.What exactly is deliberative democracy? Why is it more defensible than its rivals? By offering clear answers to these timely questions, Gutmann and (...) Thompson illuminate the theory and practice of justifying public policies in contemporary democracies. They not only develop their theory of deliberative democracy in new directions but also apply it to new practical problems. They discuss bioethics, health care, truth commissions, educational policy, and decisions to declare war. In "What Deliberative Democracy Means," which opens this collection of essays, they provide the most accessible exposition of deliberative democracy to date. They show how deliberative democracy should play an important role even in the debates about military intervention abroad.Why Deliberative Democracy? contributes to our understanding of how democratic citizens and their representatives can make justifiable decisions for their society in the face of the fundamental disagreements that are inevitable in diverse societies. Gutmann and Thompson provide a balanced and fair-minded approach that will benefit anyone intent on giving reason and reciprocity a more prominent place in politics than power and special interests. (shrink)

The demands of respect for persons when conducting clinical research are often reduced to respect for autonomy. In this paper, I re-examine the concept of respect for persons in light of important intuitions from our ordinary language usage of respect. I propose that there are many ways to respect persons as persons and that the core elements of respect for persons are: appreciating what is valuable or important about a person, recognizing the constraints or demands that such a valuation places (...) on one's own conduct, and acting in a way that expresses that recognition. On this account, in addition to autonomous agency, respect demands attention to important subjective experiences, persons' existence as part of communities, and considerations of comportment. This account has important implications for the conduct of clinical research with persons who are autonomous as well as with those who are not. Its implications, however, are different for these two populations, particularly with regard to concerns about well-being. (shrink)

S. 39: "My project in this paper is to develop the initial distinction which I have drawn between recognition and appraisal respect into a more detailed and specific account of each. These accounts will not merely be of intrinsic interest. Ultimately I will use them to illuminate the puzzles with which this paper began and to understand the idea of self-respect." 42 " Thus, insofar as respect within such a pursuit will depend on an appraisal of the participant from the (...) perspective of whatever standards are held to be appropriate to the pursuit, such respect will depend on a judgement to which excellences of character are thought relevant. Note that exactly what aspect of the person's character is thought to be relevant in this instance is his recognition respect (or lack of it) for the standards of the pursuit." 44 "This attitude fails of being appraisal respect in that my having it toward the person is conditional on those traits being such as to make him server a particular purpose that I happen to have" 44 - 45 "To sum up: Appraisal respect is an attitude of positibe appraisal of a person either judged as a person or as engaged in some more specific pursuit. In the first case, the appropriate grounds are features of the person's character: dispositions to act for particular reasons or a higher-level disposition to act for the best reasons. In the second case, though features of character do not exhaust the appropriate grounds for appraisal respect, some such character traits will be relevant (recognition respect for the standards of a particular pursuit). Also, the other features which constitute the appoprate excellences of the pursuit must be related to traits of character in the way specified. In both cases, the positive appraisal of the person, and of his traits, must be categorical. It cannot depend on the fact that the person, because of his traits, serves an interest or purpose of one's own." 45 "To have recognition respect for someone as a person is to give appropriate weight to the fact that he or she is a person by being willing to constrain one's behaviour in ways required by that fact." 45 "This is rather different from having an attitude of appraisal respect for someone as a person. The latter is a positive appraisal oif an individual made with regard ti those features which are excellences of persons. As such, it is not owed to everone, for it may or may not be merited. When it is, what is merited is just the positive appraisal itself." 47 "Second, the only beings who are approriate objects of appraisal respect are those who are capable of acting for reasons and hence capable of conceiving of various facts as meriting more or less consideration in deliberation.". (shrink)

The analysis presented here lays out the ethical warrants for requiring community oversight of health research conducted in international settings. It reviews the inadequacies with the current standards of individual informed consent and research ethics committee review, and then, shows how a broader population-based public health perspective raises new demands on justice involving due consideration of the rights, harms and benefits to the community as a whole. As developed here, an ethical standard that requires community oversight of health research is (...) justified on three principled grounds: respect for community autonomy and their right to self-determination; due consideration of the consequences of the research for the community as a whole; and, a more complete understanding of human autonomy. The paper concludes with practical recommendations regarding the composition of Community Advisory Boards to ensure that they have legitimate decision-making authority in diverse socio-cultural contexts. (shrink)

Although for the last 50 years, ethicists dealing with human experimentation have focused primarily on the need to protect individual research subjects and vulnerable groups, biomedical research, especially in genetics, now requires the establishment of standards for the protection of communities. We have developed such a strategy, based on five steps. (i) Identification of community characteristics relevant to the biomedical research setting, (ii) delineation of a typology of different types of communities using these characteristics, (iii) determination of the range of (...) possible community protections, (iv) creation of connections between particular protections and one or more community characteristics necessary for its implementation, and (v) synthesis of community characteristics and possible protections to define protections appropriate for each type of community. Depending on the particular community, consent and consultation, consultation alone, or no added protections may be required for research. (shrink)