Health Care Ethics
McAnulty College and Graduate School of Liberal Arts
Henk ten Have
Global Bioethics, Global Governance, Global Health Governance, Healthcare Ethics, Health Research, Research Ethics
Global Governance is the way by which various affairs of human social life at the global scale are governed in the absence of a global governance. This field is composed of complex networks of role players. Global Health Governance is a branch of Global Governance that governs the health-related affairs. An important branch of this huge complex of networks that has not been analyzed sufficiently in the scholarly literature yet is Global Governance for Health Research. Global health research, although it is a part of global health affairs, has its own features and conditions that bring about its specific issues and challenges at the global scale. Therefore, Global Governance for Health Research, although is generally a part of Global Health Governance, has major differences (along with similarities and overlaps) with it in different aspect, including the major role-players, ethical authorities and institutions, and the main issues and challenges.
This dissertation classifies the major role players of Global Governance for Health Research into the state and non-state role players. The major state role-players of Global Health Governance are intergovernmental organizations such as the World Health Organization (WHO), the World Bank, and UNESCO. The non-state organizations include the World Medical Association (WMA) and numerous other civil society and philanthropic organizations and corporations. The WHO and the World Bank, although important in the realm of global research, have not been the most influential role-payers in Global Governance for Health Research. Since the Global Governance for Health Research has mainly been materialized through internationally recognized frameworks and guidelines, the organizations that created, adopted, and promulgated these instruments have been the most influential role-players in the realm of Global Governance for Health Research, among them being the UNESCO, WMA, and CIOMS.
Global Governance for Health Research has its own challenges that are discussed in chapter 3 and studied through cases in chapter 4 of this dissertation. Challenges such as exploitation and helicopter research, double standards, bilateralism, the impact of bio-politics, ethical imperialism and colonialism, and the problem of data sharing and big data. The framework of gaps is also relevant to this field and the knowledge, normative, policy, institutional, and compliance gaps show themselves in Global Governance for Health Research. The cases discussed in this dissertation include the Zika Pandemic, the Research integrity in Iran, HIV/AIDS Research in Africa, Sending Biological Specimens Abroad (the problem of Bio-piracy), Research on Pre-Implantation Human Embryo, and Local and International Alternative Medicines. Each of these cases portrays a specific set of challenges and gaps in the current situation of Global Governance for Health Research. In addition, it has been shown that most of the challenges in this area are of ethical nature. Therefore, there is a need to a systematic and comprehensive ethical framework in this arena.
This dissertation suggests an ethical framework for Global Governance for Health Research that is composed of three main elements. A virtue-based element/layer that encompasses three moral virtues of empathy, compassion, and care. These virtues are the most basic moral attributes of physicians/health researchers and underlie their ethical behavior and their compliance to the principles. A two-layered principle-based element that encompasses a layer of fundamental principles, i.e. Human Dignity, Human Rights, and Non-Exploitation and a layer of more specific or practical principles that mostly adopted from the UNESCO Declaration of Bioethics and Human Rights to have a comprehensive and universal approach and from the NIH framework to have a research-oriented systematic approach. And the last element of the suggested framework is inspired by particularism or situation ethics that demands establishing, empowering, and strengthening networks of oversight and review committees/boards to guarantee the continual and comprehensive case-by-case ethical review and oversight and monitoring all over the gigantic networks involved in global health research enterprise.
Despite the existing challenging trends such as neoliberalism, isolationism, and protectionism in the Western countries and fundamentalism in some developing countries it seems that the suggested framework can be helpful in shedding ethical light on the challenges of Global Governance for Health Research and in filling its various gaps. This study is a small step in filling the knowledge gap. The suggested framework can fill part of the normative gap, this framework can be an ethical basis for policies that may fill the policy gap, the situation-ethics element of the framework is concerning the necessity and the ethical way for filling the institutional gap and finally, removing or alleviating the moral barriers is one of the ways for filling the compliance gap. Filling these gaps is not a one-time mission, instead, the process of developing and filling these gaps is continuous and will continue as long as the Global Governance for Health research is a reality on the global scene. In the final part of this dissertation, a number of practical and research recommendations and suggestions are provided.
Aramesh, K. (2017). An Ethical Framework for Global Governance for Health Research (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/121
Available for download on Sunday, November 11, 2018