Family Practice Vol. 19, No. 2, 212
© Oxford University Press 2002
Book Review |
The ethics of medical research on humans.
Claire Foster. (172 pages, paperback £17.95, hardback £50.) Cambridge University Press, 2001. ISBN paperback 0-521-64573-5, hardback 0-521-64196-9.
Wolfson Professor of General Practice, Guy's, King's & St Thomas' School of Medicine, London
At a time when the actions of medical professionals are under intense scrutiny, when newly marketed drugs prove to have serious adverse effects and in a climate of spiralling litigation, the ethical basis of medical research must be well established and well understood. This really excellent book provides a superb guide to the ethical issues surrounding medical research on humans and provides a framework of moral thinking that is likely to find international applicability.
Drawing on the already extensive literature, and particularly borrowing from Ronald Dworkin's work on political philosophy, Foster delineates three approaches to the ethics of research on humans. The goal-based approach, also known as consequentialism, judges an action's moral worth by its predicted or actual outcome. Goal-based morality is concerned, for example, with the likely impact of the research findings on health. The duty-based deontological approach, which Foster calls duty-based morality, provides rules of conduct related to the nature of actions themselves and concerned with the way the research is conducted, rather than what it is trying to achieve. An example of duty-based morality includes not harming the subjects of research. Finally, right-based deontological moral thinking provides a counterbalance to the paternalistic notions of the doctor's duty, and these rights include that to self-determination and to autonomy. Practical examples include ensuring that research participants' consent is sought and that their confidentiality is respected.
The book provides clear and detailed explanations of the philosophical backgrounds to these three approaches and goes on to examine, in engaging and highly thought-provoking detail, specific, practical examples of research to which these approaches can be applied. These range across an examination of the methodologies of research, the critical issue of equipoise in randomized controlled trials, the difficult question of non-therapeutic research, consent and competence, confidentiality and the timely and taxing issues of transplantation and cloning.
In the concluding sections, Foster proposes a framework for ethical review, in which the three approaches may be combined. There are useful summaries of goal-based, duty-based and right-based questions that need to be asked about research projects, and a fascinating section on resolving conflicts between the three approaches. The relevance of this framework to research ethics committees is discussed.
The book is beautifully written. The language is lucid, unambiguous, direct and affecting. The reader cannot avoid being repeatedly stimulated and made to question assumptions and prejudices. This is the sort of book that, if only students read books these days, should be read early in the undergraduate medical curriculum, and read again by anyone involved in research or research administration.
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