对跨国人体研究剥削议题的伦理审视

发布时间：2018-02-26 18:20

  本文关键词： 跨国人体研究 剥削 全球正义　出处：《中山大学》2016年博士论文　论文类型：学位论文

【摘要】：随着人体研究全球化的勃兴,跨国人体研究中发展中国家人类受试者遭受滥用与剥削的隐忧引发社会关切。跨国人体研究具有三个特殊性:其一,跨国人体研究不一定满足发展中国家的健康需要及优先性设定;其二,风险完全由发展中国家人类受试者承担;其三,研发成功产品可及性存在不确定性。基于发展中国家缺乏完备的人体研究法规及有效的伦理审查机制,引发了安慰剂对照试验中医疗照顾之双重标准、知情同意实效性之质疑以及试验的公平受益等涉及剥削议题之持续二十多年的激战与论辩。当代北美生命伦理学者对于跨国人体研究剥削议题的探讨成果较为丰硕,本研究首先重点解读了其中五位重要代表人物的剥削观及立场。艾伦?沃特海默在粗略的剥削定义基础上,依据被剥削者是否受益区分伤害性剥削与互利性剥削;依据被剥削者同意与否划分同意式剥削与非同意式剥削,其认为应当禁止伤害性、非同意式剥削;然而,当跨国人体研究属于同意互利式剥削应得到允许。安吉拉?巴兰廷则对艾伦的结论进行限制,提供了一个以评估剥削强度的互利式交易分析框架,旨在探讨减少而非完全消除互利性交易中的剥削。詹妮弗?霍金斯基于批驳研究者义务之医学模型,认为研究者没有为受试者提供最佳医疗照顾的义务,仅具有一个好撒马利亚人之不完全义务。当未履行该义务时,构成了一种非伤害性剥削。安德鲁?西格尔基于康德主义,认为跨国人体研究存在三种剥削形式,其一,涉及破坏或干扰人类理性能力的剥削,即知情同意有效性相关的剥削;其二,对人格尊严贬损式剥削,通常源自于试验申办者与试验受试者之间贫富差距与权力上的不平等;其三,涉及到侵犯行善义务的剥削。第三种剥削是跨国人体研究中最为普遍的剥削形式,侵犯行善义务存在两种道德错误:剥削与冷漠。剥削表现为A对B的基本需要漠不关心的同时,利用B的不利处境进行交易并从中受益。有些跨国人体研究不仅对东道国民众紧迫健康需要无动于衷而且获益于这种不利处境时构成剥削。有些跨国人体研究虽未构成剥削但却冷漠对待东道国民众紧迫的健康需要。露丝?麦克林基于脆弱性的剥削观,对跨国人体研究中可能涉及剥削的五种代表性情况进行了分析,强调了在预防、减少和避免剥削中,发展中国家的自主能动性的作用。基于马克思主义理论视角对北美学者观点的优势与限度进行了总体评判,虽然北美学者皆持非马克思主义的剥削观与程度不一的可允许剥削立场,其中最为极端的是沃特海默的立场。北美学者观点的根本缺陷在于聚焦微观分析,限于交换领域与交换正义等。本研究提出马克思式可允许剥削观:基于当前发展中国家生产力的发展状况和发展水平,在全面慎思考量下,允许为了公民更为重要的人权利益、满足国家健康需要的自愿互利式剥削。然而,解放全人类,追求人类全面自由发展的马克思主义有着强大的批判精神与进取精神,消除剥削是必然目标。针对这一议题,本研究分析了北美学者们应对跨国人体研究剥削的解决思路及策略。伊曼纽尔等驳斥了合理可及性要求,诉诸宽泛利益观与发展中国家自主权,提出公平利益框架(公平利益、合作伙伴关系与透明性三原则);约翰?兰登教授则在对公平利益框架的精辟驳斥下,提出人类发展路径;安吉拉?巴兰廷重视与关切发展中国家贫困群体的基本需要,提出最大最小化原则与国际人体研究税的策略;涛慕思?博格基于全球正义理论的高度提出远见卓识的创新策略——健康影响力基金。这些见解启发我们,对于跨国人体研究伦理争论本质是全球秩序不公正所造成发达国家与发展中国家健康不平等的又一体现,需要寻求全球正义理论的指导。最后,从治理的视角出发,阐明跨国人体研究治理与全球健康治理的内在联系,指出跨国人体研究治理的目标——跨国人体研究应当为全人类健康服务,而非仅为世界上少数发达国家及其富裕公民健康服务。以全球治理与国家治理的良性互动之实践路径,迈向更为公平公正的跨国人体研究。
[Abstract]:With the globalization of human research development of transnational human studies in developing human subjects suffering from abuse and exploitation caused worries to social concerns. Transnational human research has three characteristics: first, transnational human studies do not necessarily meet the health needs of the developing countries and priority setting; second, the risk of developing countries by human subjects bear third, there is uncertainty; the successful development of product availability. Lack of complete and effective regulations of human research ethics review mechanism based on developing countries, triggered a placebo-controlled trial of double standards in medical care, informed consent of the effectiveness of questioning and trial involving the exploitation of fair benefit issues for more than 20 years of fighting and debate to investigate the results of human studies. For transnational exploitation issues of contemporary North American bioethics scholar fruitful, the research first To focus on the interpretation of the five important representatives of the view and exploitation position. Alan? Voight's definition based on the exploitation in the rough, on the basis of the exploited are the benefits of sexual exploitation and mutual harm distinguish sexual exploitation; exploited according to agree or not agree to divide type of exploitation and without the consent of the type of exploitation, the prohibition of damage should be, without the consent of type exploitation; however, when transnational human research belongs to the type of exploitation should be allowed to benefit. Angela? Restrictions on Alan Baran Argentina provides a conclusion, to assess the strength of mutually beneficial trade exploitation framework aims to reduce rather than eliminate beneficial transactions in the exploitation Jennifer? Hawkins medical researchers criticize obligation model based on that the researchers did not provide the best medical care obligations as subjects, only to have a good Samaritan incomplete meaning Wu. When did not fulfill the obligations, constitute a non damaging exploitation. Andrew Seagal? Based on Kantian, multinational human studies there are three forms of exploitation, one involving damage or interfere with human rational ability exploitation, that informed consent is the effectiveness of exploitation; second, the dignity of derogatory type of exploitation, usually between the applicant and the test from the test subjects and the gap between the rich and the poor power inequality; thirdly, involving violations of the obligations of good exploitation. Third kinds of exploitation is the most common form of transnational exploitation in human studies, there are two kinds of moral obligation violation of good error: exploitation and exploitation show indifference. A is indifferent basic needs for B at the same time, to benefit from trading with adverse situation of B. Some transnational human studies not only on the host country people urgent health needs and benefit from this completely indifferent Unfavorable situation of transnational exploitation. Some human studies did not constitute exploitation but indifference to the host country people urgent health needs. Ruth? Mclean vulnerability exploitation based on the concept of five representative cases may involve the exploitation of transnational human studies are analyzed, emphasis on prevention, reduce and avoid exploitation in developing countries, the initiative role. Advantages and limitations from the perspective of Marx theory on the North American scholars view based on the overall evaluation, although North American scholars hold non Marx's view and the exploitation degree is not an allowable exploitation position, one of the most extreme is Voight's stance is to focus on the micro. Analysis of fundamental flaws in North American scholars point of view, to exchange and exchange field of justice. This study proposes Marx can be allowed to exploit view: the current production based on developing countries The development status and level of development in full force, think carefully about the amount, in order to allow citizens more important human rights and interests, to meet the health needs of the national voluntary benefit type exploitation. However, the liberation of all mankind, the pursuit of human freedom and all-round development of the Marx doctrine has a strong critical spirit and enterprising spirit, the elimination of exploitation is inevitable objective. To solve this issue, this study analyzes the solutions and Strategies of North American scholars dealing with transnational human research exploitation. Emanuel refuted the reasonable accessibility requirements, resorting to the broad view of interests and developing autonomy, puts forward the equity interest framework (equity interests, partnerships and transparency principle; three) John? Professor Landon in the refutation of fair interest framework incisive, put forward human development path; BA LAN Ting Angela? Attention and concern the basic needs of poverty in developing countries,. The maximum and minimum principle and Research on international human tax policy; Tao mousse? Berg global justice theory based on the height of the proposed innovation -- the health impact fund strategy. These visionary insight inspires us for transnational human research ethics debate is the essence of the global order of injustice caused by the developed countries and the developing countries health inequality reflects another the need for global justice, the guidance of the theory. Finally, from the perspective of governance, relationship governance and transnational human studies to clarify the global health governance, pointed out that the goal of transnational human research governance: transnational human studies should be for human health services, not only a few of the world's developed countries and health services to wealthy citizens. The interaction between the practice path of global governance and national governance, transnational human studies towards a more fair.

【学位授予单位】：中山大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：B82-0
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本文编号：1539115