Moral Entanglements: The Ancillary-Care Obligations of Medical Researchers

Hardcover | September 12, 2012

byHenry S. Richardson

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The philosopher Henry Richardson's short book is a defense of a position on a neglected topic in medical research ethics. Clinical research ethics has been a longstanding area of study, dating back to the aftermath of the Nazi death-camp doctors and the Tuskegee syphilis study. Most ethical regulations and institutions (such as Institutiional Review Boards) have developed in response to those past abuses, including the stress on obtaining informed consent from the subject. Richardson points out that that these ethical regulations do not address one of the key dilemmasfaced by medical researchers - whether or not they have obligations towards subjects who need care not directly related to the purpose of the study, termed "ancillary care obligations." Does a researcher testing an HIV vaccine in Africa have an obligation to provide anti-retrovirals to those whobecome HIV positive during the trial? Should a researcher studying a volunteer's brain scan, who sees a possible tumor, do more than simply refer him or her to a specialist? While most would agree that some special obligation does exist in these cases, what is the basis of this obligation, and whatare its limits? Richardson's analysis of those key questions and the development of his own position are at the heart of this book, which will appeal to bioethicists studying research ethics, to policy makers, and to political and moral philosophers interested in the obligations of beneficence, oneof the key issues in moral theory.

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The philosopher Henry Richardson's short book is a defense of a position on a neglected topic in medical research ethics. Clinical research ethics has been a longstanding area of study, dating back to the aftermath of the Nazi death-camp doctors and the Tuskegee syphilis study. Most ethical regulations and institutions (such as Inst...

Henry S. Richardson is Professor of Philosophy at Georgetown University and the author of Democratic Autonomy (OUP 2003)

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Format:HardcoverDimensions:272 pages, 8.25 × 5.5 × 0.98 inPublished:September 12, 2012Publisher:Oxford University PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0195388933

ISBN - 13:9780195388930

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Table of Contents

Preface1. Medical Researchers' Ancillary-Care Obligations:A Perplexing IssueAncillary-Care Obligations and the Distinctive Ancillary-Care Obligation2. Special Ancillary-Care Obligations: The Partial-Entrustment ModelThe Existing Lack of GuidanceScope: Partial Entrustment of Aspects of HealthThe Variable Strength of Ancillary-Care ClaimsCombining the Tests of Scope and StrengthControversy Surrounding the Scope Requirement3. The Moral Basis of the Partial EntrustmentA Range of IntimaciesThe Duty to WarnAutonomy-Centered Reasons for Privacy RightsAncillary Duties of CareWhy Those Accepting Privacy Waivers Take on Special ResponsibilitiesHow the Duty to Warn Blocks Maintaining a Tactful SilenceHow the Duty to Warn Indirectly Supports Tactful EngagementHow the Duty of Tactful Engagement Provides a Focus for BeneficenceReturning to the Context of Medical ResearchPotential Rival Accounts: Vulnerability and Threat Avoidance4. Justice, Exploitation, and Ancillary CareWhy Special Ancillary-Care Obligations Cannot Rest on JusticeWill Providing Ancillary Care Conflict with Justice?Justice Reinforcing Ancillary-Care Claims5. Limits on the Waiver of Ancillary-Care ObligationsThe Difficulty of Annulling Ancillary-Care ClaimsMoral Constraints on Soliciting Waivers of Ancillary-Care Claims6. Gradations of Ancillary-Care ResponsibilityWithin the Scope: Minimally, Clearly, or Centrally?Variations in the Expectable Depth of the Researcher-Participant RelationshipVariation in Relative CostPutting These Factors TogetherConclusion7. Issues for Further ExplorationNeeded Conceptual WorkWhat Does It Mean To Provide Ancillary Care?Who Are the Researchers?Who Are "Participants"?What are some of the important boundaries of "medical research"?What if ancillary non-medical problems are encountered?Needed Empirical Work8. Philosophical Implications and Practical StepsPractical StepsReferencesTablesTable 1: General and Special Grounds of Ancillary-Care ObligationsTable 2: Functions of Obtaining Informed ConsentFiguresFigure 1: The Partial-Entrustment Model's Two TestsFigure 2: The Elements Generating Privacy-Based Moral EntanglementsFigure 3: Privacy-Based Moral Entanglements: Putting the Pieces TogetherFigure 4: Four Grades of Ancillary-Care Obligation for ART ProvisionCasesAdvanced Cervical Cancer in a HIV-transmission StudyBrain ScansGrimes v. the Kennedy Krieger InstituteJubaMalaria Researchers and SchistosomiasisN's Seatmate's PillsQuinodyneThe Massage Therapist and the MoleThe Nepal Newborn Washing StudyThe Old Man and the GroceriesThe Participant's Feverish ChildThe Reporter and the PeasantThe Tax Accountant and the Gambling AddictTransfusion for a Jehovah's WitnessWelts