Moral Entanglements: The Ancillary-Care Obligations of Medical Researchers

272 Pages·2012·1.1 MB·English

by  Henry S. Richardson

MORAL ENTANGLEMENTS
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MORAL ENTANGLEMENTS
The Ancillary-Care Obligations
of Medical Researchers
Henry S. Richardson
1
3
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Library of Congress Cataloging-in-Publication Data
Richardson, Henry S.
Moral entanglements : the ancillary-care obligations
of medical researchers / Henry S. Richardson.
p. ; cm.
Includes bibliographical references.
ISBN 978–0–19–538893–0 (alk. paper)
I. Title.
[DNLM: 1. Research Personnel—ethics. 2. Biomedical Research—ethics.
3. Health Care Rationing—ethics. 4. Moral Obligations. W 20.55.E7]
174.2’8—dc23
2012004799
1 3 5 7 9 8 6 4 2
Printed in the United States of America
on acid-free paper
For Ben and Hope
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CONTENTS
List of Tables, Figures, and Cases ix
Preface xi
1. Medical Researchers’ Ancillary-Care Obligations:
A Neglected Issue 1
A Perplexing Issue 5
Ancillary-Care Obligations and the Distinctive
Ancillary-Care Obligation 12
2. Special Ancillary-Care Obligations: Th e
Partial-Entrustment Model 23
Th e Existing Lack of Guidance 24
Scope: Partial Entrustment of Aspects of Health 31
Th e Variable Strength of Ancillary-Care Claims 41
Combining the Tests of Scope and Strength 49
Controversy Surrounding the Scope Requirement 51
3. Th e Moral Basis of the Partial-Entrustment Model 59
A Range of Intimacies 71
Th e Duty to Warn 75
Autonomy-Centered Reasons for Privacy Rights 78
vii
CONTENTS
Ancillary Duties of Care 84
Returning to the Context of Medical Research 96
Potential Rival Accounts: Vulnerability
and Th reat Avoidance 98
4. Justice, Exploitation, and Ancillary Care 107
Why Special Ancillary-Care Obligations
Cannot Rest on Justice 110
Will Providing Ancillary Care Confl ict
with Justice? 118
Justice Reinforcing Ancillary-Care Claims 128
5. Limits on the Waiver of Ancillary-Care Obligations 133
Th e Diffi culty of Annulling Ancillary-Care Claims 135
Moral Constraints on Soliciting Waivers
of Ancillary-Care Claims 143
6. Gradations of Ancillary-Care Responsibility 153
Within the Scope: Minimally, Clearly,
or Centrally? 157
Variations in the Expectable Depth of the
Researcher–Participant Relationship 161
Variation in Relative Cost 163
Putt ing Th ese Factors Together 165
Conclusion 168
7. Issues for Further Exploration 171
Needed Conceptual Work 174
Needed Empirical Work 198
8. Philosophical Implications and Practical Steps 203
Philosophical Implications 205
Practical Steps 216
References 229
Index 239
viii
LIST OF TABLES, FIGURES, AND CASES
Tables
Table 1 General and Special Grounds of Ancillary-Care
Obligations 15
Table 2 Functions of Obtaining Informed Consent 34
Figures
Figure 1 Th e Partial-Entrustment Model’s Two Tests 50
Figure 2 Th e Elements Generating Privacy-Based Moral
Entanglements 62
Figure 3 Privacy-Based Moral Entanglements: Putt ing
the Pieces Together 87
Figure 4 Four Grades of Ancillary-Care Obligation
for ART Provision 167
Cases
Advanced Cervical Cancer in a HIV-Transmission Study 18, 104,
197
Brain Scans 5, 25–26, 36, 37, 97, 175, 190, 197
Malaria Researchers and Schistosomiasis 4, 11, 16, 17, 36, 49n.,
50, 64, 88n., 96, 105, 174, 197
Th e Massage Th erapist and the Mole 21n., 77, 92, 100
N’s Seatmate’s Pills 140
Th e Old Man and the Groceries 66, 68, 73, 88n., 92, 95, 96, 103
Th e Participant’s Feverish Child 185
Quinodyne 116, 131 -132
ix