Two Models in Global Health Ethics

Public Health Ethics 2009 doi: 10.1093/phe/php032

This paper examines two strategies aimed at demonstrating that moral obligations to improve global health exist.
The ‘humanitarian model’ stresses that all human beings, regardless of affluence or global location, are fundamentally the same in terms of moral status. This model argues that affluent global citizens’ moral obligations to assist less fortunate ones follow from the desirability of reducing disease and suffering in the world. The ‘political model’ stresses that the lives of the world’s rich and poor are inextricably linked because of harmful state-to-state actions and because of the currently existing transnational institutions. These institutions’ design at once secures the high standard of living of the affluent and reinforces the continued foreseeable—and avoidable—deprivation of many of the global poor; and these give rise to compensatory health-related moral obligations beyond borders.
This paper argues that political reasoning is unsuitable for the crucial task of determining priority in the receipt
of health aid. We conclude that in the context of global health ethics, political reasoning must be supplemented
with, if not replaced by, humanitarian reasoning.

Peter Singer

co-authored with Christopher Lowry in: A Companion to Philosophy in Australasia, (eds.) G. Oppy, N. Trakakis, L. Burns, and F. Leigh (Monash ePress, forthcoming)

Questões éticas na pesquisa internacional e em estudos multicêntricos

w Darragh Hare in: Revista Electronica de Comunicacao Informacao, Inovacao em Saude DOI: 10.3395/reciis.v2.Sup1.206pt pp 19-30

Este artigo apresenta um panorama das questões-chave relativas à pesquisa internacional e aos estudos multicêntricos,
com especial ênfase na pesquisa biomédica internacional realizada nos países em desenvolvimento. Faz uma breve explicação das normas que regem a pesquisa biomédica internacional e uma exposição do debate sobre os padrões de cuidado a serem oferecidos pela pesquisa nos países em desenvolvimento e desenvolvidos. Descreve as questões ligadas à participação de grupos vulneráveis em pesquisas, com referência específica aos países em desenvolvimento. Por fim, o artigo discute temas relativos a cuidados de emergência e pós-ensaio, exploração, recompensa e indução indevida, voluntariedade e benefícios para as comunidades locais.

Ethical issues in international research and multicentre studies

w/ Darragh Hare in Electronic Journal of Communication, Information and Innovation in Health DOI: 10.3395/reciis.v2.Sup1.206en  pp 19-29

This article provides an overview of the key issues pertaining to international research and multicentre studies, with particular emphasis to international biomedical research in the developing world. The article begins with a brief explanation of the regulations governing international biomedical research and an exposition of the debate surrounding the standards of care that should be provided by research conducted in the developing and developed countries. The article describes the issues involved in the participation of vulnerable groups in research, with specific reference to developing countries. Eventually, the article considers matters related to emergency and post-trial care, exploitation, reward and undue inducement, voluntariness and benefits to local communities.

Human Self-Determination, Biomedical Progress and God

this is a chapter in the forthcoming volume Blackford/Schuklenk: 50 Voices of Disbelief, Wiley-Blackwell 2009.

Terminal Illness and Access to Phase 1 Experimental Agents, Surgeries and Devices: Reviewing the Ethical Arguments

with Christopher R Lowry, British Medical Bulletin

The advent of AIDS brought about a group of patients unwilling to accept crucial aspects of the methodological standards for clinical research investigating phase 1 drugs. Their arguments against placebo controls in trials, which depended – at the time – on the terminal status of patient volunteers, led to a renewed discussion of the ethics of denying patients with catastrophic illnesses access to last-chance experimental drugs, surgeries or devices. At stake are questions about the kinds of personal sacrifices society can reasonably expect patients in clinical trials to make in order to ensure statistically predictive results. These would benefit by necessity a much larger number of current and future patients – the conflict is about individual versus public interests. It is also about the question of whether or not the state can legitimately prevent patients with terminal illnesses from unfettered access to experimental drugs, surgeries or devices in order to motivate them to participate in clinical trials. We review the ethical arguments for and against the provision of access to phase 1 agents for terminally ill patients.

Review Article: Should We Use the Criminal Law to Punish HIV Transmission?

forthcoming: International Journal of Law in Context

Why Some HIV Transmissions Should Be Punished

This is a commentary published in the Hastings Center's Bioethics Forum in November 2008

Rethinking Mandatory HIV Testing During Pregnancy in High HIV-prevalence Regions: Ethical and Policy Issues.

American Journal of Public Health 2007; 97; 1179-1183 (w A Kleinsmidt)

North-South Benefit Sharing Arrangements in Bioprospecting and Genetic Research: A Critical Ethical and Legal Analysis.

Developing World Bioethics 2006; 6: w A Kleinsmidt

SPECIAL ISSUES IN RESEARCH ETHICS

co-authored with Benjamin Schneider in DEVELOPING WORLD BIOETHICS 2005; 5

ABSTRACT
The objective of this module is to cover ground that was not covered indepth in any of the other modules, including: scientific misconduct, issues concerning the publication and ownership of research results (authorship guidelines – who is eligible to be considered an author, or contributor to a scientific paper etc.), special problems occurring in social science and
epidemiological research, and the problems pertaining to conflicts of interest the various players in biomedical research activities could encounter.

Globalisation and Health: A Developing World Perspective on Ethical and Policy Issues

with Braimo Bello in: B Bennett and GF Tomossy (eds). Globalisation and Health. Springer: Berlin 2005: 13-26

Introduction to Research Ethics

in DEVELOPING WORLD BIOETHICS 2005; 5: 1-13.

ABSTRACT
This module will introduce you to the ethical concepts underlying applied ethical decision-making in the area of research involving human participants.
We will also learn what the issues are that people involved in
research on research ethics are concerned with. Ethics without an understanding of historical and legal context makes arguably little sense. It is for this reason that this module will begin with a brief history of research ethics and ends with a brief overview of the relevant national and international guidelines pertaining to ethical issues in research involving human participants.

Introducao a Etica em Pesquisa

published in: Debora Diniz, Dirce Guilhem and Udo Schuklenk (eds). Etica na Pesquisa. Letras Livres: Brasilia 2005

The Ethics of Genetic Research on Sexual Orientation

Hastings Center Report 1997; 27(4): 6-13 (w E Stein, W Byne, J Kerin)

Affordable access to essential medication in developing countries: conflicts between ethical and economic imperatives.

Journal of Medicine and Philosophy 2002; 27: 179-195 (w R Ashcroft)

AIDS: Bioethics and Public Policy

published in: New Review of Bioethics 2003; 1(1): 127-144

International Research Ethics

Bioethics 2000; 14: 158-172 (with R Ashcroft)

Professional Responsibilities of Biomedical Scientists in Public Discourse.

Journal of medical ethics 2004; 30: 53-60

Bioethics

with Jacinta Kerin, in: N.J. Schmelser et al (eds.) International Encyclopedia of the Social and Behavioural Sciences. Elsevier: Dordrecht 2001: 1195-1201

Unethical Perinatal HIV Transmission Trials Establish Bad Precedent

published in BIOETHICS 1998; 12: 312-319

Protecting the Vulnerable: Testing Times for Clinical Research Ethics

Social Science and Medicine 2000; 51: 969-977

Drug Testing and Approval in Cases of People with Catastrophic Illnesses: Ethical Issues

published in: Clinical Research and Regulatory Affairs 1998; 15: 145-157