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Trading participation for access to health-care: A morally relevant feature of participation in clinical research

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)1-14
JournalJOSHA - Journal of Science, Humanities and Arts
Issue number4
Early online date28 Jul 2016
Accepted/In press28 Jul 2016
E-pub ahead of print28 Jul 2016
Published12 Sep 2016


King's Authors


The increasing tendency to run clinical trials offshore in low - and middle - income count ries (LMICs) has been extensively documented. In parallel, in high - income countries (HICs) as the US, we are witnessing the emergence of new forms of clinical research where un(der)insured fractions of the population are trading access for participation to health - care to which they would otherwise not have access. We first discuss Wertheimer’s analysis of offshored clinical trials as mutually advantageous exploitative transa ctions. We then argue that to make sense of what is morally problematic with the offshoring of clinical research it is necessary to broa den the ethical analysis, as there are different kinds of moral wrongs that can be linked to exploitatio n . We then further broaden our gaze beyond exploitation to analyse a distinct sort of moral wrong inherent in the off - shoring of clinical research, namely the sponsors’ complicity in perpetuating the injustice of the background conditions of the participan ts. W e argue that both modes of participation in clinical research highlighted above share the feature of ‘trading participation for access to health - care’, and that this is a morally relevant characteristic that should be taken into consideration in the ethical 2 analysis, and that in some case s justify intervention to prevent subjects from participating in clinical trials. We conclude that as health - care provision and clinical trial participation have been and cont inue to be strictly intertwined both in LMICs and in HICs, in both contexts , there is a need to devise ways to make the inclusion of economically disadvantaged and un insured individuals in clinical research as fair as pos sible

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