Moral Entanglements

Moral Entanglements : The Ancillary-Care Obligations of Medical Researchers

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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 Institutional 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 dilemmas faced 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 who become 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 what are 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, one of the key issues in moral more

Product details

  • Hardback | 272 pages
  • 149.86 x 210.82 x 27.94mm | 430.91g
  • Oxford University Press Inc
  • New York, United States
  • English
  • New.
  • 0195388933
  • 9780195388930
  • 1,461,721

About Henry S. Richardson

Professor of Philosophy, Georgetown University,show more

Review quote

"Henry Richardson has the rare talent of digging deep theoretically, while being attentive to contextual complexities and constraints of practice. For a decade he has been exploring the moral landscape of medical researchers' ancillary care responsibilities. This inquiry has yielded a carefully crafted and rigorously argued book. Through comprehensively examining ancillary care obligations, Richardson illuminates the neglected phenomenon of moral entanglements that arise in professional encounters, and in ordinary life, when privacy rights are waived. Reading his book will reward all those interested in the ethics of clinical research, professional ethics, and moral philosophy." -Franklin G. Miller, Ph.D., Department of Bioethics, National Institutes of Health "In this wonderful book-distinguished by very careful philosophical analysis and real-world examples-Henry Richardson elaborates the "partial-entrustment" model he and Leah Belsky first advanced a decade ago regarding researchers' obligations to provide care that is ancillary to the purposes of their research projects. He situates this model in a broader set of "entanglements" that will feel very familiar to any person who has engaged not only in medical research but in any complex inter-personal interaction that isn't cabined by the four corners of an explicit contract. Everyone with an interest in biomedical research and research ethics should read this book: they will profit both from recognizing the pervasive issues on which it shines a bright light and from its thoughtful and nuanced responses." - Alexander M. Capron, University Professor, University of Southern California & Former Director, Ethics, Trade, Human Rights and Health Law, WHO "This book sets out the most comprehensive framework to date for delineating the special responsibilities of researchers to address healthcare needs encountered in research in low-resource settings. By asserting that when particular moral conditions can be met, researchers have obligations to take demanding steps to address entrusted conditions, the account in this book provides decision-makers at the coalface with a clear focus. The author also clearly sets out how this framework relates to previous conceptual contributions to the contested area of 'ancillary care' obligations in research." - Catherine Slack, HIV AIDS Vaccines Ethics Group, South African AIDS Vaccines Initiative, South Africa "As the author notes in his conclusion, the 'practical neglect of the issue of ancillary care seems to have been accompanied by a widely shared theoretical blind spot.' But Richardson has remedied that error of omission and left us with a fine volume that will be a touchstone for future scholarship and regulation. It is an inspired and highly readable analysis." -- Notre Dame Philosophical Reviews "Moral Entanglements repays close study and sets a fine example of the kind of work to which normative ethics should aspire: engaged, relevant, philosophically rich, and insightful." -- Ethicsshow more

Table of contents

Preface ; Chapter 1: Medical Researchers' Ancillary-Care Obligations: ; A Perplexing Issue ; Ancillary-Care Obligations and the Distinctive Ancillary-Care Obligation ; Chapter 2: Special Ancillary-Care Obligations: The Partial-Entrustment Model ; The Existing Lack of Guidance ; Scope: Partial Entrustment of Aspects of Health ; The Variable Strength of Ancillary-Care Claims ; Combining the Tests of Scope and Strength ; Controversy Surrounding the Scope Requirement ; Chapter 3: The Moral Basis of the Partial Entrustment ; A Range of Intimacies ; The Duty to Warn ; Autonomy-Centered Reasons for Privacy Rights ; Ancillary Duties of Care ; Why Those Accepting Privacy Waivers Take on Special Responsibilities ; How the Duty to Warn Blocks Maintaining a Tactful Silence ; How the Duty to Warn Indirectly Supports Tactful Engagement ; How the Duty of Tactful Engagement Provides a Focus for Beneficence ; Returning to the Context of Medical Research ; Potential Rival Accounts: Vulnerability and Threat Avoidance ; Chapter 4: Justice, Exploitation, and Ancillary Care ; Why Special Ancillary-Care Obligations Cannot Rest on Justice ; Will Providing Ancillary Care Conflict with Justice? ; Justice Reinforcing Ancillary-Care Claims ; Chapter 5: Limits on the Waiver of Ancillary-Care Obligations ; The Difficulty of Annulling Ancillary-Care Claims ; Moral Constraints on Soliciting Waivers of Ancillary-Care Claims ; Chapter 6: Gradations of Ancillary-Care Responsibility ; Within the Scope: Minimally, Clearly, or Centrally? ; Variations in the Expectable Depth of the Researcher-Participant Relationship ; Variation in Relative Cost ; Putting These Factors Together ; Conclusion ; Chapter 7: Issues for Further Exploration ; Needed Conceptual Work ; What Does It Mean To Provide Ancillary Care? ; Who Are the Researchers? ; Who Areshow more

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