_Teachers Investigate Their Work_ introduces the methods and concepts of action research through examples drawn from studies carried out by teachers. The book is arranged as a handbook with numerous sub-headings for easy reference and fourty-one practical methods and strategies to put into action, some of them flagged as suitable `starters'. Throughout the book, the authors draw on their international practical experience of action research, working in close collaboration with teachers. It is an essential guide for teachers, senior staff and (...) co-ordinators of teacher professional development who are interested in investigating their own practice in order to improve it. (shrink)
In this article, I bring together Hannah Arendt’s and Simone de Beauvoir’s respective theories of political judgment to evaluate the problems that arise from their accounts of judgment in praxis. To do so, I compare Arendt’s Eichmann in Jerusalem: A Report on the Banality of Evil on Adolf Eichmann’s trial in Israel and Beauvoir’s “An Eye for an Eye” on Robert Brasillach’s trial in France. In approaching the dilemmas of judgment in theory, both share a commitment to preserving freedom by (...) virtue of our human plurality. In practice, however, both respectively demand the death penalty for Eichmann and Brasillach. I identify three distinct failures of political judgment in praxis: from the accused, the courts, and Arendt and Beauvoir, respectively. I contend that Arendt and Beauvoir fail to appropriately judge Eichmann and Brasillach by arguing for their execution, because it constitutes a form of political violence that undermines their theoretical accounts of judgment. (shrink)
This new edition brings together the English translation of the renowned Plato scholar and translator, Seth Benardete, with two illuminating commentaries on it: Benardete's "On Plato's Symposium" and Allan Bloom's provocative essay, "The ...
Michael Winkelman, who is a senior lecturer in the department of anthropology, Arizona State University, and director of its ethnographic field school, has provided a rich overview of the neurophenomenology of shamanism in his book, Shamanism: The Neural Ecology of Consciousness. Written in the tradition of Laughlin, McManus, and d'Aquili's 1992 classic, Brain, Symbol, and Experience: Toward a Neurophenomenology of Consciousness, Winkelman considers shamanism in many of its facets. He explores shamanism's social and symbolic content, and the implications of its (...) neurological underpinnings both for shamanic practitioners and for their clients. (shrink)
In this collection of critical essays, Dominick LaCapra, with characteristic verve, takes on a variety of authors who have addressed issues relating to intellectual history, history generally, violence, trauma, and the relation between the human and the animal. LaCapra offers two types of criticism—of historians for ignoring or misappropriating theory, and of theorists for engaging in “theoreticism,” a theorizing that rides roughshod over historical specificity and context. The present essay focuses on LaCapra’s discussion of the theoreticism of the critical theorists (...) Giorgio Agamben, Eric L. Santner, and Slavoj Žižek, and in particular on their and LaCapra’s attempts to engage with the “issue of the postsecular.” Although Agamben, Santner, and Žižek highlight some important and provocative issues, this brand of critical theory provides too limited a base for coming to an understanding of current debates over the relation between religion and secular perspectives. Instead, one must approach “postsecularity” with attentiveness to the larger “secularization debate,” and to the way the term postsecular is used by such writers as Jürgen Habermas and John Milbank. LaCapra rightly draws attention to the recent emergence of a discourse of “the postsecular.” Both the term and the concept now cry out for a deeper, more critical, and more historical examination than has so far been attempted. (shrink)
It has been suggested that community advisory boards can play a role in minimising exploitation in international research. To get a better idea of what this requires and whether it might be achievable, the paper first describes core elements that we suggest must be in place for a CAB to reduce the potential for exploitation. The paper then examines a CAB established by the Shoklo Malaria Research Unit under conditions common in resource-poor settings – namely, where individuals join with a (...) very limited understanding of disease and medical research and where an existing organisational structure is not relied upon to serve as the CAB. Using the Tak Province Border Community Ethics Advisory Board as a case study, we assess the extent to which it might be able to take on a role minimising exploitation were it to decide to do so. We investigate whether, after two years in operation, T-CAB is capable of assessing clinical trials for exploitative features and addressing those found to have them. The findings show that, although T-CAB members have gained knowledge and developed capacities that are foundational for one-day taking on a role to reduce exploitation, their ability to critically evaluate studies for the presence of exploitative elements has not yet been strongly demonstrated. In light of this example, we argue that CABs may not be able to perform such a role for a number of years after initial formation, making it an unsuitable responsibility for many short-term CABs. (shrink)
Thus far, little work in bioethics has specifically focused on global health research priority-setting. Yet features of global health research priority-setting raise ethical considerations and concerns related to health justice. For example, such processes are often exclusively disease-driven, meaning they rely heavily on burden of disease considerations. They, therefore, tend to undervalue non-biomedical research topics, which have been identified as essential to helping reduce health disparities. In recognition of these ethical concerns and the limited scholarship and dialogue addressing them, we (...) convened an international workshop in September 2015. The workshop aimed to initiate discussion on the appropriate relationship between global and national levels of health research priority-setting and to begin exploring what might be ethically required for priority-setting at each of those levels. This paper comprises our reflections following the workshop. Its main objective is to launch a research agenda for the ethics of global health research priority-setting. We identify three domains of global health research priority-setting—scope, underlying values and substantive requirements, and procedural considerations. For each domain, specific research questions are highlighted and why they need to be explored is explained. Some preliminary thoughts and normative arguments as to how the research questions might be answered are also offered. For example, we provide initial ideas about the appropriate relationship between different priority-setting levels and what values and substantive considerations should guide or underpin global health research priority-setting as a matter of justice. We anticipate that framing a new research agenda for the ethics of global health research priority-setting will spur ethicists, researchers, and policymakers to refocus their efforts on developing more rigorous and ethically sound approaches to priority-setting. (shrink)
The successful demonstration that antiretroviral (ARV) drugs can be used in diverse ways to reduce HIV acquisition or transmission risks – either taken as pre-exposure prophylaxis (PrEP) by those who are uninfected or as early treatment for prevention (T4P) by those living with HIV – expands the armamentarium of existing HIV prevention tools. These findings have implications for the design of future HIV prevention research trials. With the advent of multiple effective HIV prevention tools, discussions about the ethics and the (...) feasibility of future HIV prevention trial designs have intensified. This article outlines arguments concerning the inclusion of newly established ARV-based HIV prevention interventions as standard of prevention in HIV prevention trials from multiple perspectives. Ultimately, there is a clear need to incorporate stakeholders in a robust discussion to determine the appropriate trial design for each study population. (shrink)
In order to fulfill ABET requirements, Northern Arizona University’s Civil and Environmental engineering programs incorporate professional ethics in several of its engineering courses. This paper discusses an ethics module in a 3rd year engineering design course that focuses on the design process and technical writing. Engineering students early in their student careers generally possess good black/white critical thinking skills on technical issues. Engineering design is the first time students are exposed to “grey” or multiple possible solution technical problems. To identify (...) and solve these problems, the engineering design process is used. Ethical problems are also “grey” problems and present similar challenges to students. Students need a practical tool for solving these ethical problems. The step-wise engineering design process was used as a model to demonstrate a similar process for ethical situations. The ethical decision making process of Martin and Schinzinger was adapted for parallelism to the design process and presented to students as a step-wise technique for identification of the pertinent ethical issues, relevant moral theories, possible outcomes and a final decision. Students had greatest difficulty identifying the broader, global issues presented in an ethical situation, but by the end of the module, were better able to not only identify the broader issues, but also to more comprehensively assess specific issues, generate solutions and a desired response to the issue. (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)
Debates about justice in international clinical research problematically conflate two quite different forms of obligation. International research ethics guidelines were intended to describe how to conduct biomedical research in a just manner at the micro or clinical level (within the researcher-participant interaction) but have come to include requirements that are clearly intended to promote justice at the global level. Ethicists have also made a variety of claims regarding what international research should contribute to global justice. This paper argues that the (...) conflation of debates about justice at the micro and macro-levels has not only resulted in the placement of obligations upon the wrong actors but has also served to exclude relevant actors from the ethical picture. Suggestions for who should properly bear macro-level obligations of justice in international clinical research are offered. The paper further contends that, unlike researchers who violate informed consent requirements, no similar type of accountability exists for obligations of global justice, even for those obligation-bearers (incorrectly) identified by current ethics guidelines. (shrink)
Allan Hazlett challenges the philosophical assumption of the value of true belief. He critiques the view that true belief is better for us than false belief, and the view that truth is "the aim of belief". An alternative picture is provided, on which the fact that some people love truth is all there is to "the value of true belief".
This article draws attention to the limited amount of scholarship on what constitutes fairness and equity in resource allocation to health research by individual funders. It identifies three key decisions of ethical significance about resource allocation that research funders make regularly and calls for prioritizing scholarship on those topics – namely, how health resources should be fairly apportioned amongst public health and health care delivery versus health research, how health research resources should be fairly allocated between health problems experienced domestically (...) versus other health problems typically experienced by disadvantaged populations outside the funder's country, and how domestic and non-domestic health research funding should be further apportioned to different areas, e.g. types of research and recipients. These three topics should be priorities for bioethics research because their outcomes have a substantial bearing on the achievement of health justice. The proposed agenda aims to move discussion on the ethics of health research funding beyond its current focus on the mismatch between worldwide basic and clinical research investment and the global burden of disease. Individual funders’ decision-making on whether and to what extent to allocate resources to non-domestic health research, health systems research, research on the social determinants of health, capacity development, and recipients in certain countries should also be the focus of ethical scrutiny. (shrink)
It is widely believed that such old-fashioned questions have been rendered absurd by the materialism of modern empirical science, but some seemingly 'magical' properties of quantum mechanics have brought them back into serious discussion in some circles. I will examine the possibility of making miracles using well-established principles of quantum mechanics--in particular, the possibility that quantum theory allows for the most desirable ' miracle ' of all: immortality.
International research is an essential means of reducing health disparities between and within countries and should do so as a matter of global justice. Research funders from high-income countries have an obligation of justice to support health research in low and middle-income countries that furthers such objectives. This paper investigates how their current funding schemes are designed to incentivise health systems research in LMICs that promotes health equity. Semi-structured in-depth interviews were performed with 16 grants officers working for 11 funders (...) and organisations that support health systems research: the Alliance for Health Policy and Systems Research, Comic Relief, Doris Duke Foundation, European Commission, International Development Research Centre, Norwegian Agency for Development Cooperation, Research Council of Norway, Rockefeller Foundation, UK Department of International Development, UK Medical Research Council, and Wellcome Trust. Thematic analysis of the data demonstrates their funding schemes promote health systems research with five key features that advance health equity: being conducted with worst-off populations, focusing on research topics that advance equitable health systems, having LMIC ownership of the research agenda, strengthening LMIC research capacity, and having an impact on health disparities. The different types of incentives that encouraged proposed projects to have these features are identified and classified by their strength. It is suggested that research funders ought to create and maintain funding schemes with strong incentives for the features identified above in order to more effectively help reduce global health disparities. (shrink)
The concepts of meaning and mental content resist naturalistic analysis. This is because they are normative: they depend on ideas of how things ought to be. Allan Gibbard offers an expressivist explanation of these 'oughts': he borrows devices from metaethics to illuminate deep problems at the heart of the philosophy of language and thought.
there seems to be some kind of asymmetry, at least in some cases, between moral testimony and non-moral testimony, between aesthetic testimony and non-aesthetic testimony, and between religious testimony and non-religious testimony. In these domains, at least in some cases, we object to deference, and for this reason expect people to form their beliefs on non-testimonial grounds, in a way that we do not object to deference in paradigm cases of testimonial knowledge. Our philosophical puzzle is therefore: what explains these (...) (apparent) asymmetries (or are they merely apparent)? My aim here is to criticize three accounts of these testimonial asymmetries and to suggest an alternative strategy for solving our puzzle. I’ll consider the idea that testimony cannot be a source of understanding (§2), the idea that testimony cannot be a source of acquaintance (§3), and the idea that testimonial belief is not conducive to moral virtue (§4). These accounts all explain the badness of testimonial belief, in the relevant cases, by appeal to its consequences for the believer—respectively, a lack of understanding, acquaintance, or moral virtue. I’ll conclude by suggesting a way forward (§5): we should try to understand the badness of testimonial belief, in the relevant cases, as deriving from its consequences for the believer’s society. (shrink)
Scholarship focusing on how international research can contribute to justice in global health has primarily explored requirements for the conduct of clinical trials. Yet health systems research in low- and middle-income countries has increasingly been identified as vital to the reduction of health disparities between and within countries. This paper expands an existing ethical framework based on the health capability paradigm – research for health justice – to externally-funded health systems research in LMICs. It argues that a specific form of (...) health systems research in LMICs is required if the enterprise is to advance global health equity. “Research for health justice” requirements for priority setting, research capacity strengthening, and post-study benefits in health systems research are derived in light of the field's distinctive characteristics. Specific obligations are established for external research actors, including governments, funders, sponsors, and investigators. How these framework requirements differ from those for international clinical research is discussed. (shrink)
In this research, we examine the relationship between employee psychological entitlement and employee willingness to engage in unethical pro-organizational behavior. We hypothesize that a high level of PE—the belief that one should receive desirable treatment irrespective of whether it is deserved—will increase the prevalence of this particular type of unethical behavior. We argue that, driven by self-interest and the desire to look good in the eyes of others, highly entitled employees may be more willing to engage in UPB when their (...) personal goals are aligned with those of their organizations. Support for this proposition was found in Study 1, which demonstrates that organizational identification accentuates the link between PE and the willingness to engage in UPB. Study 2 builds on these findings by examining a number of mediating variables that shed light on why PE leads to a greater willingness among employees to engage in UPB. Furthermore, we explored the differential effects of PE on UPB compared to counterproductive work behavior. We found support for our moderated mediation model, which shows that status striving and moral disengagement fully mediate the link between PE and UPB. PE was also linked to CWB and was fully mediated by perceptions of organizational justice and moral disengagement. (shrink)
The principle of providing post-trial access for research participants to successful products of that research is widely accepted and has been enshrined in various declarations and guidelines. While recent ethical guidelines recognise that the responsibility to provide post-trial access extends to sponsors, regulators and government bodies as well as to researchers, it is the researchers who have the direct duty of care to participants. Researchers may thus need to act as advocates for trial participants, especially where government bodies, sponsors, and (...) regulatory bodies have complex interests vested in decisions about whether or not new interventions are made available, how, and to whom. This paper provides an empirical account of post-trial access in the context of HIV prevention research. It describes both access to the successful products of research and the provision antiretroviral drugs for trial participants who acquire HIV. First, we provide evidence that, in the current system, there is considerable variation in the duration and timeliness of access. We then argue that by analysing the difficulties faced by researchers to this point, and their efforts to meet this obligation, much can be learned about how to secure post-trial access in HIV biomedical preventions trials. While researchers alone have a limited obligation, their advocacy on behalf of trial participants may be necessary to call the other parties to account. (shrink)
This paper considers some empirical research into the modelling of moral values in schools, which highlights the hidden impact of working environments on classroom relationships. After an initial survey and pilot study, a range of primary, secondary and student teachers, selected for their empathy, were interviewed and observed in order to understand the nature of empathy in different contexts. The findings revealed four particular types of empathy used in learning relationships: fundamental, functional, profound and feigned. Of these, functional, used in (...) large classes, was the most common, but revealed considerable negative implications for the moral model offered by state education. Profound empathy, more rarely seen, developed through close and frequent interaction and held the most beneficial consequences for moral modelling, learning relationships and achievement. However, the economic values embedded in the structures and systems of the state education sector, typified by large classes, restrict the flourishing of profound empathy. (shrink)
Many nonhuman animals produce facial expressions which sometimes bear clear resemblance to the facial expressions seen in humans. An understanding of this evolutionary continuity between species, and how this relates to social and ecological variables, can help elucidate the meaning, function, and evolution of facial expression. This aim, however, requires researchers to overcome the theoretical and methodological differences in how human and nonhuman facial expressions are approached. Here, we review the literature relating to nonhuman facial expressions and suggest future directions (...) that could facilitate a better understanding of facial expression within an evolutionary context. (shrink)
We propose an account of dynamic predicates which draws on the notion of force, eliminating reference to events in the linguistic semantics. We treat dynamic predicates as predicates of forces, represented as functions from an initial situation to a final situation that occurs ceteris paribus, that is, if nothing external intervenes. The possibility that opposing forces might intervene to prevent the transition to a given final situation leads us to a novel analysis of non-culminating accomplishment predicates in a variety of (...) languages, including the English progressive. We then apply the force-theoretic framework to the composition of basic Vendlerian eventuality types within a lexical-decomposition syntax. The difference between predicates of forces and predicates of situations is argued to underlie the dynamic/stative contrast, and also to allow for a formal treatment of the difference between be and stay. Consequences for the relationship between language and cognition are discussed. (shrink)
Vaccination is a highly effective public health strategy that provides protection to both individuals and communities from a range of infectious diseases. Governments monitor vaccination rates carefully, as widespread use of a vaccine within a population is required to extend protection to the general population through “herd immunity,” which is important for protecting infants who are not yet fully vaccinated and others who are unable to undergo vaccination for medical or other reasons. Australia is unique in employing financial incentives to (...) increase vaccination uptake, mainly in the form of various childcare payments and tax benefits linked to timely, age-appropriate vaccination. Despite relatively high compliance with the childhood vaccination schedule, however, the Australian government has determined that rates should be higher and has recently introduced policy that includes removing certain tax and childcare benefits for non-vaccinators and formally disallowing conscientious objection to vaccination. In addition, it has raised the possibility of banning unvaccinated children from childcare centres. This article examines the impact of coercive approaches to childhood vaccination and raises the question of the ethical justification of health policy initiatives based on coercion. We consider the current evidence regarding childhood vaccination in Australia, the small but real risks associated with vaccination, the ethical requirement for consent for medical procedures, and the potential social harms of targeting non-vaccinators. We conclude that the evidence does not support a move to an increasingly mandatory approach that could only be delivered through paternalistic, coercive clinical practices. (shrink)
Published data show that new HIV prevention strategies including treatment-as-prevention and pre-exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV-based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether moral claims justify the provision (...) of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment-as-prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment-as-prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment-as-prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV-based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)
In 2010, randomized controlled trials (RCTs) of two different biomedical strategies to prevent HIV infection had positive findings. However, despite ongoing very high levels of HIV infection in some countries and population groups, it has been made clear by regulatory authorities that the evidence remains insufficient to support either product being made available outside of research contexts in the developing world for at least two years. In addition, prevention trials in endemic areas will continue to test new interventions against placebo. (...) But the judgments of evidentiary standards are never value-neutral. Using the recent trials and their contexts as case studies, we examine the basis for these decisions, which will potentially delay access to scientific innovation to the people who are most urgently in need of it. (shrink)
In Experiment, Right or Wrong, Allan Franklin continues his investigation of the history and philosophy of experiment presented in his previous book, The Neglect of Experiment. Using a combination of case studies and philosophical readings of those studies, Franklin again addresses two important questions: What role does and should experiment play in the choice between competing theories and in the confirmation or refutation of theories and hypotheses? How do we come to believe reasonably in experimental results? Experiment, Right or (...) Wrong makes a significant contribution to an important area in contemporary history and philosophy of science. Philosophers and historians of science, physicists, and advanced students in these areas will find much of interest in this engaging study. (shrink)
Global health research partnerships are increasingly taking the form of consortia of institutions from high-income countries and low- and middle-income countries that undertake programs of research. These partnerships differ from collaborations that carry out single projects in the multiplicity of their goals, scope of their activities, and nature of their management. Although such consortia typically aim to reduce health disparities between and within countries, what is required for them to do so has not been clearly defined. This article takes a (...) conceptual approach to explore how the governance of transnational global health research consortia should be structured to advance health equity. To do so, it applies an account called shared health governance to derive procedural and substantive guidance. A checklist based on this guidance is proposed to assist research consortia determine where their governance practices strongly promote equity and where they may fall short. (shrink)
Health research has been identified as a vehicle for advancing global justice in health. However, in bioethics, issues of global justice are mainly discussed within an ongoing debate on the conditions under which international clinical research is permissible. As a result, current ethical guidance predominantly links one type of international research (biomedical) to advancing one aspect of health equity (access to new treatments). International guidelines largely fail to connect international research to promoting broader aspects of health equity – namely, healthier (...) social environments and stronger health systems. Bioethical frameworks such as the human development approach do consider how international clinical research is connected to the social determinants of health but, again, do so to address the question of when international clinical research is permissible. It is suggested that the narrow focus of this debate is shaped by high-income countries' economic strategies. The article further argues that the debate's focus obscures a stronger imperative to consider how other types of international research might advance justice in global health. Bioethics should consider the need for non-clinical health research and its contribution to advancing global justice. (shrink)
In this surprising book, Allan V. Horwitz argues that our current conceptions of mental illness as a disease fit only a small number of serious psychological conditions and that most conditions currently regarded as mental illness are cultural constructions, normal reactions to stressful social circumstances, or simply forms of deviant behavior.
This paper approaches the question of awareness outside of attention through a broader psychological examination of human consciousness. Questions regarding the boundaries of conscious awareness, as well as the possibility of 'subconscious' or 'unconscious' mental processes, were widely discussed 100 years and more ago when they played a central role in the thinking of turn-of-thecentury theorists such as William James, F.W.H. Myers, Jean-Martin Charcot, and Pierre Janet, all of whom were interested in dissociative phenomena suggestive of consciousness, or awareness, beyond (...) the margins of attention. Such phenomena included hypnosis, hysteria, trance states, and motor automatisms, and for many scholars also sleep related conditions such as dreaming and hypnogogic states. (shrink)
We often prefer non-deferential belief to deferential belief. In the last twenty years, epistemology has seen a surge of sympathetic interest in testimony as a source of knowledge. We are urged to abandon ‘epistemic individualism’ and the ideal of the ‘autonomous knower’ in favour of ‘social epistemology’. In this connection, you might think that a preference for non-deferential belief is a manifestation of vicious individualism, egotism, or egoism. I shall call this the selfishness challenge to preferring non-deferential belief. The aim (...) of this paper is to meet the selfishness challenge by arguing that non-deferential belief is socially valuable. (shrink)
As the price of oil climbs toward $100 a barrel, our impending post-fossil fuel future appears to offer two alternatives: a bleak existence defined by scarcity and sacrifice or one in which humanity places its faith in technological solutions with unforeseen consequences. Are there other ways to imagine life in an era that will be characterized by resource depletion? The French intellectual Georges Bataille saw energy as the basis of all human activity--the essence of the human--and he envisioned a society (...) that, instead of renouncing profligate spending, would embrace a more radical type of energy expenditure: la depense , or "spending without return." In Bataille's Peak , Allan Stoekl demonstrates how a close reading of Bataille--in the wake of Giordano Bruno and the Marquis de Sade-- can help us rethink not only energy and consumption, but also such related topics as the city, the body, eroticism, and religion. Through these cases, Stoekl identifies the differences between waste, which Bataille condemned, and expenditure, which he celebrated. The challenge of living in the twenty-first century, Stoekl argues, will be to comprehend--without recourse to austerity and self-denial--the inevitable and necessary shift from a civilization founded on waste to one based on Bataillean expenditure. Allan Stoekl is professor of French and comparative literature at Penn State University. He is the author of Agonies of the Intellectual: Commitment, Subjectivity, and the Performative in the Twentieth-Century French Tradition and translator of Bataille's Visions of Excess: Selected Writings, 1927-1939 (Minnesota, 1985). (shrink)
This article examines the relationship between bioethics and the therapeutic standards in HIV prevention research in the developing world, focusing on the closure of the pre-exposure prophylaxis (PrEP) trials in the early 2000s. I situate the PrEP trials in the historical context of the vertical transmission debates of the 1990s, where there was protracted debate over the use of placebos despite the existence of a proven intervention. I then discuss the dramatic improvement in the clinical management of HIV and the (...) treatment access movement, and consider how these contexts have influenced research practice. I argue that as HIV prevention trials oblige researchers to observe the rate at which vulnerable people under their care acquire HIV, there is an obligation to provide antiretroviral treatment to seroconverters and other health care benefits that fall within the scope of researchers' entrustment, both to avoid exploitation and to enact reciprocal justice. I argue against propositions that the obligations to provide specific benefits are vague, fall only upon researchers and sponsors, and create injustices by privileging the few over the many. Finally, I contend that the realisation of a broader standard of care in HIV prevention research broadens the role of research from being a simple tool to produce knowledge to a complex intervention that can play a part in the reduction of health disparities. (shrink)