Ethical issues in the use of human subjects.

Abstract

ions such as good of mankind or rights of the individual and be clear about what ends and values science can and should serve. With the articulation of such-ends we may well find the grounds to say why each of us should be willing to serve as research subjects for the good, not of mankind, but of the communities in which we exist.5 Because we do not share these values, however, the only way we feel that we can protect ourselves from one another is by insisting on the procedural rule of informed consent. In other words, what we have here is the typical liberal strategy to substitute procedure for the absence of debate on substantive norms and values. 3. Therapeutic and Non-Therapeutic Experimentation It can be objected that I have overstated the unclarity of the moral values and ends that give direction to contemporary research. To be sure, there is an important distinction between therapeutic and nontherapeutic experimentation that suggests we have a clearer idea of what we are doing in therapeutic cases. But we also know that this distinction is often easier to draw in theory than it is in practice. For example, there are good grounds to think, in spite of the wide practice of kidney transplants, that such procedure is still an experimental technique.6 Furthermore, it remains unclear if random clinical trials should be viewed as therapeutic or non-therapeutic even though medical progress depends on such testing.7 For the issue is: medical progress for whom the immediately sick person or future patient populations? question of who the doctor's patient is or should be is often not easy to determine, but it is complicated by the realization that we are no longer sure what health and illness mean. As Charles Fried has suggested, The concept of good health implies a concept of the good life, and the goodness of life includes a large number of other factors besides simply its length.8 Thus the doctor's primary duty is not the prevention of death, but rather the preservation of bodily integrity necessary for the realization of a and realistic life 9 But we have little consensus about what kind of medicine should be developed since we are unclear what constitutes a reasonable and realistic life plan. But concretely this means we have no way of determining whether we should develop heart transplant procedures in order to provide some with opportunities not normally thought to be a possibility. For the expense of providing those opportunities for some must lessen basic medical care for others. Even if we knew better what health means or should mean it is unclear how this would help us direct the research not directly associated with therapeutic ends. For example, some of the hard cases involving the use of human subjects in research are clearly non-therapeutic that is the research aims to obtain information of use to 252 Linacre Quarterly others and thus does not pretend to treat some illness that the experimental subject might have. Thus the justification for using human subjects in such research is made more intense because the design and ends of such experiments are remote from the therapeutic context.