Towards Progress in Resolving Dilemmas in International Research Ethics

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In scientific cultures awareness of alternatives is highly developed and challenges to established knowledge are welcomed. In traditional cultures there is no developed awareness of alternatives to the established body of theoretical tenets and any challenge to established knowledge is a threat of chaos and invokes intense anxiety. There is also a difference in magical versus non-magical attitude to words. In non-scientific cultures words have power to influence events. Knowing the name of a being or thing is to have some degree of control over it. The scientific attitude to words is quite different and words and reality are independent variables. Horton R. , “African Traditional Thought and Western Science,” in Mosely A. ed., African Philosophy (Englewood Cliffs: New Jersey Prentice Hall, 1995): 310–338.

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Mackling supra note 3.

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Macklin , supra note 1.

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While the research endeavor is not directly responsible for such disparities, those involved in research are indirectly co-opted into a global political economy that has profoundly adverse implications for health. As such researchers have an obligation not to contribute to aggravating disparities, but rather to assist in narrowing them.

A lengthy patient information/informed consent form containing detailed information about investigations and procedures that does not provide information about poor prognosis (for examples in trials of new drugs for metastatic carcinoma where median survival is often very short and minimal prolongation of life is anticipated with new treatments) and no indication of what ‘response’ to ‘active’ drugs means in terms of prolongation of life or improvement in quality of life, can hardly be considered a universal standard. Gostin L. , “Informed Consent, Cultural Sensitivity, and respect for Persons,” JAMA 274, no 10 (1995): 844–5; Marshall P.A. , “The Relevance of Culture for Informed Consent in U.S.- Funded International Health Research: Findings and Recommendations from the Case Study on Informed Consent for Genetic Epidemiological Studies of Hypertension, Breast Cancer, and Diabetes Mellitus in Nigeria,” Commissioned Paper for National Bioethics Advisory Commission: Ethical and Policy Issues in International Research: Clinical Trials in Developing Countries Vol. II (May 2001): C1–C38; Lindegger G. and Richter L. , “HIV Vaccine Trials: Critical Issues in Informed Consent,” South African Journal of Science 96 (2000): 313–17.

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Benatar S.R. and Singer P.A. , “A New Look at International Research Ethics,” British Medical Journal 321 (2000): 824–26.

Shapiro K. and Benatar S.R. , “HIV Prevention Research and Global Inequality: Steps Towards Improved Standards of Care” Journal of Medical Ethics (2004) In press.

Benatar S.R. , “Some Reflections and Recommendations on Research Ethics in Developing Countries,” Social Science & Medicine 54, no. 7 (2002): 1131–41, 1147–48.