Some argue that there is a moral obligation for people to participate in a research study at least once in their lifetime. The idea is that medicine provides beneficence to humans, and thus, it is a moral obligation to participate in research to advance the medical body of knowledge. Moreover, participation in research will provide benefit to all humans. This argument takes a consequentialist viewpoint, implying we will either benefit ourselves, or that others will benefit from our sacrifices. While it is true that humans benefit from medical research, and many do deem healthcare as their right, the idea of there being a moral obligation to participate in research for its beneficence is wrong.
The philosophical principle of deontology asserts that morality is not determined by the risk/reward rationale argued by utilitarianism.i Rather, morality is determined by the treatment of humans, and the inherent value placed on their life.ii Since man has a duty to not wrong others, promote good, and treat each other as equals, participation in research that does not follow these principles would not be considered a moral obligation.iii Such a study would treat the person as a means to an end, as a tool for the researcher, and take away the equality of the participant.iv
The German philosopher Hans Jonas made the point that people are used as a means to achieve an end all the time; whether it is a supervisor using his employee to achieve a business objective, or the patient using their doctor to achieve personal health.v In a social context this behaviour happens all the time. However, in clinical research, Hans Jonas asserts that people are “a mere token, a sample merely to be acted upon.”vi The Philosopher Immanuel Kant argued that, to see people as tools to achieve goals destroys the inherent value in the person. If there is no goal to simultaneously provide beneficence to the patient, then there is no moral obligation for the patient to participate.vii
This paper will observe the morality of participation in research study and take the side against the existence of any moral obligation to participate in medical research. No such moral obligation exists that could cause a person to give up their rights and equal status as a human for medical science and become a research subject even once in their lifetime. This paper will argue that there is no moral obligation to participate in research study because medical progress is an optional social goal, inconsequential to humanities survival, and anyone wishing to provide beneficence can do so through alternative means.
The general thought process is that the basic necessities of life are food, clothing and shelter. Everything else is optional and excessive. It is told that Gautama Buddha moved to the forest, foregoing the need for shelter. The ultimate goal of Jainism is to forego the need for food. Before cities and civilization sprouted up, humans were perfectly capable of surviving with these basic needs. They survived on their primitive instincts. Unlike our genetic cousins, the Neanderthals, humans found a way to survive. So it is inconsequential to require participation in medical studies for our basic survival.
Probably the most notable example to show that there is no moral obligation to participate in research study is the Willowbrook study.viii In his article exposing the ethical violations of research physicians, Henry K. Beecher described violations that occurred at the Willowbrook Institute.ix He asserted that conditions were horrid and that the mentally retarded children admitted to the research ward were purposely exposed to hepatitis.x The researchers at the institute coerced parents to admit their children, with the promise that they would be sent to the care facility afterwards.xi Their rationale was that the children would be exposed to hepatitis anyway, so there was value in studying otherwise healthy children who were exposed at early stages.xii Research studies that were conducted in manners similar to that of the Institute held the utilitarian viewpoint that sacrifice of some children was acceptable so long as there was a benefit to the greater population.
The Willowbrook Institute overlooked their moral obligation to provide the children with care, and overlooked the inherent value of the childrens’ lives. Rather, it rationalized the favorable consequences of their actions over the unfavorable consequences. They violated two of the three principles of deontology; having wronged others, and having not treated others as equals.xiii Moreover, the parents had no moral obligation to admit their children to a study that would put them at more risk, even if the end result would be more rewarding.
John Locke asserted that when there is a population that comes together and form a social institution, they give discretion to that body to make decisions on their behalf.xiv That institution is formed on the basis of making decisions for the common good of its members.xv Thus, the members are morally obliged to participate in actions that are to the beneficence of that institute, since they are the ultimate benefactors.
According to John Locke, we would be morally obliged to participate in medical research studies, since we owe it to our fellow members of the institution of medicine. However, as mentioned, humans have survived hundreds of generations without advancements in medical science. According to Hans Jonas, medical research is an extraordinary means of serving the common good.xvi Therefore, there is no moral obligation to take extra steps for others. It can also be argued that because not all humans are doctors and scientists, they do not belong to the actual institution of medicine, and are thus, only beneficiaries. By agreeing to pay taxes that fund the healthcare system, the citizens of the nation are no longer obligated to participate in any way that benefits medicine.xvii Their moral obligation lies solely in the funding of healthcare. In nations where universal healthcare is not instated, there is no obligation for anyone to participate in research studies, since not everyone is entitled to its benefits. Those that wish benefits, fulfill their obligation through their payment to the doctor at the time of visit, or through insurance payments.
According to Hans Jonas, humans only have a moral obligation to participate in research study if there is a ‘collective emergency’ like war or widespread epidemic.xviii For example, if a plague similar to the Black Death hit Canada, there may be a moral obligation for widespread volunteerism. Volunteering for research would help medical researchers determine the cause of the disease, and formulate a cure, or preventative measure. Even then, a moral obligation would only exist if there was a need for more participants in human experimentation. If there are volunteers that deem it their own moral duty to participate through their own reasoned justifications, then it should not be a moral obligation for those without the disease to donate themselves.
Inmaculada de Melo-Martín writes in his paper In response to Rosamond Roche, regarding the article, Response to de Melo-Martín: “On a Putative Duty to Participate in Biomedical Research”, that
“One could argue that maybe the duty is not to advance the common good in general but a particular aspect of the common good: the prevention of disease and disability. But even if this is the case, it is clear that becoming a research subject is not the only means to contribute to morbidity and mortality prevention. Clearly, one could participate in activities that lead to a reduction of poverty, reduction of unjust inequalities, access to exercise facilities, or access to nutritious food, and so on. All of these factors, i.e., poverty, unjust inequalities, lack of nutritious food and exercise facilities, play a part in people’s health. Hence, activities that contribute toward changing these factors in adequate ways are also likely to contribute to the good of health.”xix
De Melo-Martin asserts that the greater moral objective is not to give back to science, it is to give back to society, and that this can be achieved though means other than participation in medical research. Therefore, we have no moral obligation to medical science, and no moral obligation to participate in its studies. The philosopher, Immanuel Kant would agree with this viewpoint. Kant argued that our standard of morality is determined by how we reason them out.xx If our reason would come to the same conclusions as our views, then the action is moral. He called this the categorical imperative.xxi
In application of Kant’s categorical imperative to the idea of the greater moral objective presented by de Melo-Martin, first we would have to argue that we have a moral obligation to society beyond paying taxes and being good people. If this is the case, our moral obligation to society would be determined by what we reasonably believe our duty to society would be. If we reason that our duty is to help the homeless, then that is our moral obligation. If we reason that our duty is to participate in research studies for the advancement of medicine, then that is our moral obligation. Reasonably, we must expect that not everyone will rationalize that they have the same duty to society.
According to Kant, if we deem it our moral duty to participate in a research study at least once in our lifetime, the act ceases to be a moral act if we are compensated for it.xxii We must have no subjective inclinations for our actions.
Kant’s view on moral obligation towards research participation took a distinctly deontological approach, especially when juxtaposed with the position of utilitarianism. His thought we must act purely for the sake of humanity if participating in research.xxiii We should not be a means to an end, as utilitarianism asserts, but rather, the human’s quality of life should be our goal. Any action that would pit the human as a mere tool used to achieve a goal, and not recognize their inherent value as a human the entire time cannot be deemed moral.xxiv Because this is a specific quality of most medical research, if a person deems it their duty, it can be rationalized that they have a moral obligation; however, there is no moral obligation for society at large to participate in a medical research study at least once in their lifetime.
i James Fieser, Ethics, 2006,
ii Ibid
iii Ibid
iv Ibid
v Emanuel et al., Ethical and Regulatory Aspects of Clinical Research (The Johns Hopkins University Press 2003), 2-4,19, 97, 114, 151-152, 156, 197, 211, 360
vi Ibid
vii Ibid
viii Ibid
ix Ibid
x Ibid
xi Ibid
xii Ibid
xiii James Fieser, Ethics, 2006,
xiv John Locke, The Second Treatise of Civil Government, (1690),
xv Ibid
xvi Emanuel et al., Ethical and Regulatory Aspects of Clinical Research (The Johns Hopkins University Press 2003), 2-4,19, 97, 114, 151-152, 156, 197, 211, 360
xvii De Melo-Martin, Inmaculada, “Response to Rosamond Rhodes”, APA Newsletter Vol. 7 (2008): 13-14
xviii Emanuel et al., Ethical and Regulatory Aspects of Clinical Research (The Johns Hopkins University Press 2003), 2-4,19, 97, 114, 151-152, 156, 197, 211, 360
xix De Melo-Martin, Inmaculada, “Response to Rosamond Rhodes”, APA Newsletter Vol. 7 (2008): 13-14
xx Lecture, Duff Waring (13 March, 2009).
xxi Ibid
xxii Ibid
xxiii Ibid
xxiv James Fieser, Ethics, 2006,
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