For a Few Benefits More: Justice in International Research

After long taking a backseat to Beneficence, Non-maleficence and Autonomy, the concept of Justice is experiencing a renaissance in bioethics, particularly in international research ethics. All too often in the past, international biomedical research has placed most of burdens of research on participants and communities in the developing world, while developed world has reaped most of the benefits. There is general agreement that this imbalance of benefits and burdens constitutes exploitation.

But beyond that, there are fundamental disagreements among bioethicists about what the pursuit of justice in international research involves. There currently seem to be two opposing camps forming. Let us call them the minimalist and the aspirational.

According to the minimalist camp, justice in research consists in the avoidance of exploitation, and avoiding exploitation involves a negotiation of a fair benefits/burden ratio between research host communities and research institutions. As long as the research does not make the host community worse off, provides the community with some benefits, and the community judges those benefits of research to compensate for the burdens, then such research is non-exploitative, i.e. just.

It is fair to say that the minimalist view is dominant in international research ethics. After the 2001 Conference on Ethical Aspects of Research in Developing Countries, the delegates – including some big names from big institutions -- formulated a ‘Fair Benefits’ framework of justice in research. The document gives a somewhat quaint view of international research, where creative bargains about all sorts of benefits are cheerfully struck between host communities and research institutions. Imagine the conversations: “No, sorry, we cannot give you this drug if the trial is successful. But how about 5 boreholes for clean water?” As long as the host community comes away from the negotiating table with crumbs whatever benefits are on offer, justice is served. More recent reports, such as the Nuffield Council on Bioethics latest contribution don’t depart from the trend.

Another, more ‘aspirational’ camp is emerging. In this month’s Hasting Center Report, Alex John London takes the minimalist view to task for assuming that the social, political and health care status quo in developing countries is the ‘moral baseline’ from which to evaluate justice in international research. In essence, he asks whether not making impoverished communities worse off is anything (ethically) to write home about, and whether providing the destitute with a bit of borehole benefit meets the obligations of a worthwhile concept of justice. Real justice in international research involves more: to see how much more, well, it won’t be fair to summarize. Read it yourself: (Subscription Required). - Stuart Rennie