基本説明
The philosopher Henry Richardson's short book is a defense of a position on a neglected topic in medical research ethics, termed 'ancillary care obligations'.
Full Description
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 theory.
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 Are "? ; What are some of the important boundaries of "? ; What if ancillary non-medical problems are encountered? ; Needed Empirical Work ; Chapter 8: Philosophical Implications and Practical Steps ; Philosophical Implications ; Practical Steps ; References ; Tables ; Table 1: General and Special Grounds of Ancillary-Care Obligations ; Table 2: Functions of Obtaining Informed Consent ; Figures ; Figure 1: The Partial-Entrustment Model's Two Tests ; Figure 2: The Elements Generating Privacy-Based Moral Entanglements ; Figure 3: Privacy-Based Moral Entanglements: Putting the Pieces Together ; Figure 4: Four Grades of Ancillary-Care Obligation for ART Provision ; Cases ; Advanced Cervical Cancer in a HIV-transmission Study ; Brain Scans ; Grimes v. the Kennedy Krieger Institute ; Juba ; Malaria Researchers and Schistosomiasis ; N's Seatmate's Pills ; Quinodyne ; The Massage Therapist and the Mole ; the Nepal Newborn Washing Study ; The Old Man and the Groceries ; The Participant's Feverish Child ; The Reporter and the Peasant ; The Tax Accountant and the Gambling Addict ; Transfusion for a Jehovah's Witness ; Welts
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