Front Matter Source: IRB: Ethics and Human Research, Vol. 33, No. 2 (March-April 2011) Published by: The Hastings Center Stable URL: http://www.jstor.org/stable/23048302 . Accessed: 12/06/2014 22:43 Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at . http://www.jstor.org/page/info/about/policies/terms.jsp . JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected]. . The Hastings Center is collaborating with JSTOR to digitize, preserve and extend access to IRB: Ethics and Human Research. http://www.jstor.org This content downloaded from 185.2.32.141 on Thu, 12 Jun 2014 22:43:00 PM All use subject to JSTOR Terms and Conditions
Transcript
Front MatterSource: IRB: Ethics and Human Research, Vol. 33, No. 2 (March-April 2011)Published by: The Hastings CenterStable URL: http://www.jstor.org/stable/23048302 .
Accessed: 12/06/2014 22:43
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .http://www.jstor.org/page/info/about/policies/terms.jsp
.JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range ofcontent in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new formsof scholarship. For more information about JSTOR, please contact [email protected].
.
The Hastings Center is collaborating with JSTOR to digitize, preserve and extend access to IRB: Ethics andHuman Research.
http://www.jstor.org
This content downloaded from 185.2.32.141 on Thu, 12 Jun 2014 22:43:00 PMAll use subject to JSTOR Terms and Conditions
Protecting Research Subjects: IRBs in a Changing Research
Landscape Ann Freeman Cook and Helena Hoas 14
by Erik Malmqvist
LETTERS 19
A Publication of
The Hastings Center
The
notion of exploitation frequently crops up in
discussions about the ethics of biomedical research. A standard concern about clinical trials is that
they exploit research subjects for the benefit of future patients. This concern is particularly emphasized
when participants in clinical trials are drawn from vulnerable social
groups and when research takes
place in developing countries.1
Some suggest that a major ratio
nale behind ethical principles and
guidelines governing research with humans is to avoid exploitation.2
Yet it is unclear what exploitation
means in the research context. The
lack of clarity is hardly surprising, since exploitation is not as well
established a part of the bioethics toolbox as other concepts, like
autonomy and harm. Exploitation
has also received comparatively
little philosophical attention out side of bioethics, and philosophers who have analyzed it disagree con
siderably about what exploitation
is, when it is wrong, and why.3 Although some authors in
research ethics have questioned
the usefulness of exploitation
discourse,4 recent works have
shed new light on the meaning of
exploitation in clinical research, and several common misconcep
tions have been identified and
dispelled.5 However, more concep
tual clarification is needed. This
Erik Malmqvist, "(Mis)Understanding Exploita tion," IRB: Ethics & Human Research 33, no. 2
(2011): 1-5.
paper is not an attempt to develop
a full account of exploitation in
research, nor will I try to system
atically apply any more general
theory to this particular case. I will
instead challenge one influential
way of talking about exploitation in the research context: the so
called nonexploitation framework that a group of leading research
ethicists have proposed in several
recent papers.6 I contend that one
core element of the framework—
the idea that nonexploitation in research requires that participants
are not exposed to excessive risk—
while seemingly sound, is in fact
quite mistaken and misleading. A reflection on exploitation in other
practices reveals why this is so.
The Nonexploitation Framework
The nonexploitation framework
is proposed as an alternative
to the long-prevailing view that clinical research should be guided by clinical equipoise.7 There are different interpretations of the clinical equipoise doctrine, but the central tenet is that conducting a
clinical trial is only justified when there is uncertainty about which
of the trial interventions is better.
On this view, randomization of research participants to different
trial arms is unethical when the
intervention in one of the arms is
clearly inferior to the intervention
in another arm (or to some other
intervention available in clinical
FEATURE ARTICLE
(Mis)Understanding
Exploitation
by Erik Malmqvist
The
notion of exploitation frequently crops up in
discussions about the ethics of biomedical research. A standard concern about clinical trials is that
they exploit research subjects for
the benefit of future patients. This concern is particularly emphasized
when participants in clinical trials are drawn from vulnerable social
groups and when research takes
place in developing countries.1
Some suggest that a major ratio
nale behind ethical principles and
guidelines governing research with humans is to avoid exploitation/ Yet it is unclear what exploitation
means in the research context. The
lack of clarity is hardly surprising, since exploitation is not as well
established a part of the bioethics toolbox as other concepts, like
autonomy and harm. Exploitation
has also received comparatively
little philosophical attention out side of bioethics, and philosophers who have analyzed it disagree con
siderably about what exploitation
is, when it is wrong, and why.3 Although some authors in
research ethics have questioned
the usefulness of exploitation
discourse,4 recent works have
shed new light on the meaning of
exploitation in clinical research, and several common misconcep
tions have been identified and
dispelled.5 However, more concep
tual clarification is needed. This
paper is not an attempt to develop
a full account of exploitation in
research, nor will I try to system
atically apply any more general
theory to this particular case. I will
instead challenge one influential
way of talking about exploitation in the research context: the so
called nonexploitation framework that a group of leading research
ethicists have proposed in several
recent papers.6 I contend that one
core element of the framework—
the idea that nonexploitation in research requires that participants
are not exposed to excessive risk—
while seemingly sound, is in fact
quite mistaken and misleading. A reflection on exploitation in other
practices reveals why this is so.
The Nonexploitation Framework
The nonexploitation framework
is proposed as an alternative
to the long-prevailing view that clinical research should be guided by clinical equipoise.7 There are different interpretations of the clinical equipoise doctrine, but the central tenet is that conducting a
clinical trial is only justified when there is uncertainty about which
of the trial interventions is better.
On this view, randomization of research participants to different
trial arms is unethical when the
intervention in one of the arms is
clearly inferior to the intervention
in another arm (or to some other
intervention available in clinical Erik Malmqvist, "(Mis)Understanding Exploita tion," IRB: Ethics & Human Research 33, no. 2
(2011): 1-5.
This content downloaded from 185.2.32.141 on Thu, 12 Jun 2014 22:43:00 PMAll use subject to JSTOR Terms and Conditions
