Reviews
| Date | 01 May 2002 |
| DOI | http://doi.org/10.1111/1468-2230.t01-1-00391 |
| Published date | 01 May 2002 |
REVIEWS
Claire Foster,The Ethics of Medical Research on Humans, Cambridge:
Cambridge University Press, 2001, xiii + 150pp, hb £50.00; pb £17.95.
Every time our doctor prescribes a drug or procedure to treat us, we benefit from
healthcare research. In order that advances are made in medicine it is essential that
research is fostered and encouraged. Yet, more important than the furtherance of
medical science is the principle enshrined in Article 5 of the World Medical
Association’s Declaration of Helsinki. There it is stated that ‘In medical research on
human subjects, considerations related to the well-being of the human subject should
take precedence over the interests of science and society’.
Any country wishing to ensure that progress in medicine is appropriately balanced
with the rights and interests of research participants cannot rely purely on law, which
offers neither the flexibility nor the speed with which to react to changes in medical
research. The system therefore relies on ‘research ethics committees’; groups of up to
18 volunteers from a range of medical and lay backgrounds who consider each
research proposal within the National Health Service, apply existing guidance and
decide whether or not to approve the research protocol. There is approximately one
local research ethics committee for each Health Authority in the UK. In addition
there are 8 multi-centre research ethics committees which review research protocols
involving 5 or more local research ethics committee geographical locations. This
considerably eases the burden on researchers conducting large-scale trials, though
they must still consult each relevant local research ethics committee in relation to
pertinent local issues that may affect the research. The research ethics committee
must be equipped to deal with the evolutionary nature of healthcare research. They
are aided by professional guidelines, but the guidance rarely keeps up with the
changes and controversies of research on humans. Claire Foster’s book, on the other
hand, attempts to provide research ethics committee members and researchers with
an ideologically neutral means of approaching an ethical dilemma even when
specific law and guidance is lacking. Foster calls upon her significant experience of
training ethics committee members to explain how principles of moral decision-
making can be applied in healthcare research.
The three approaches to moral decision-making are goal-based, duty-based and
right-based morality. They were put forward by Ronald Dworkin in 1977 for use in
political philosophy, and adapted to moral philosophy and medical ethics by Sophie
Botros in 1992. Goal-based morality presents a utilitarian approach, explained by
Foster in a pertinent manner providing relevant philosophical background whilst
relating specifically to scientific rigour in research. Foster stresses the limitations of
the approach and cautions against reliance on the principle in isolation. Instead she
recommends its place as part of the overall consideration of what makes a research
protocol ethical.
Duty-based morality shifts the consideration from the outcome that maximises
happiness to the action that is morally justified by its contents. On the goal-based
approach a trial withholding valuable treatment from cancer patients might be
sanctioned if it will provide useful scientific results that will significantly further the
treatment of cancer. The duty-based approach however, might prohibit such research
ßThe Modern Law Review Limited 2002 (MLR 65:2, March). Published by Blackwell Publishers,
108 Cowley Road, Oxford OX4 1JF and 350 Main Street, Malden, MA 02148, USA.476
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