Review of For the Common Good: Philosophical Foundations of Research Ethics

Abstract

Review of For the Common Good:Philosophical Foundations of Research Ethics Douglas MacKay The principal goal of Alex John London's (2022, xvii) For the Common Good is to "articulate a new vision for the philosophical foundations of research ethics" which "moves issues of justice from the periphery of the field to the very center." At the core of this new vision is an understanding of research as a "collaborative social activity between free and equal persons," which aims to develop the knowledge public institutions require to establish and maintain a social order in which people may set and pursue their plans of life (London 2022, 3). Clinical and social scientific research are not therefore morally optional activities, in London's view, but rather the way public institutions acquire the knowledge they need to discharge their obligations to create the conditions under which people may enjoy reasonable life spans, develop literacy and numeracy skills, and enjoy their rights to liberty and security. For the Common Good builds on London's prior work, with many chapters featuring revised content from previously published papers. However, it also weaves this work into a broader narrative. Readers familiar with London's work may be struck - as I was - by how well his various contributions of the past 20 years, on topics as diverse as international research ethics, learning health systems, and the purpose of prospective review, fit together into a systematic view. For the Common Good's new vision of research ethics is thus wide-ranging in scope. [End Page E-13] London's new book is a remarkable achievement. It offers a compelling and coherent vision of the philosophical foundations of research ethics, resituating the research enterprise within the broader activity of creating a just social order. By building the foundations of the field on justice, it provides an attractive, systematic alternative to prominent approaches which neglect this value in favor of the principles of beneficence and respect for persons. Despite his focus on the philosophical foundations of research ethics, moreover, London's analysis is informed by his deep knowledge of the practices of research and ethics oversight. The foundations London establishes for the field are thus not only philosophically sound, but appropriate for the construction of norms, rules, and regulations to govern health and social scientific research. In this review, I first provide an overview of London's project before offering several critical comments. Since London's book is incredibly rich and wide-ranging, my comments are necessarily limited in focus, and the issues I take up reflect my own scholarly interests and expertise. There is thus much of value in For the Common Good that I touch on only briefly, if at all. OVERVIEW For the Common Good contains a critical program and a positive program. The critical program outlines the philosophical foundations of "orthodox research ethics" and argues that these foundations are riven with fault lines that threaten to undermine the requirements they are supposed to support (London 2022, 4). Orthodox research ethics, London claims, has eight problematic commitments. First, research involves an inherent moral dilemma, whether between respect for the individual and the good of humanity, or between the clinician's fiduciary duty of care and utilitarian imperatives of the research enterprise (London 2022, 5). It is, second, a morally optional activity between private parties, in which, third, the two main stakeholders are researchers and participants – the "IRB triangle" (London 2022, 6-7). The activity of research is, fourth, defined functionally to involve procedures designed to produce generalizable knowledge which in turn informs a vision of research ethics wherein, fifth, the dueling role obligations of the clinician-researcher take center stage (London 2022, 9). The central aim of regulations is, sixth, to paternalistically protect participants from the potential abuse of researchers (London 2022, 10). Finally, because research is treated as a morally optional activity between private parties, to the extent that justice plays a role in this view, it is, [End Page E-14] seventh, not treated as a value that governs social institutions (London 2022, 11-12), but is instead, eighth, reduced to the principles of respect for persons and beneficence, amounting to voluntary transactions that benefit both...