Kate Chatfield

Ethics dumping is a global phenomenon involving the ‘off-shoring’of research. Research that would be prohibited, severely restrictedor regarded as highly patronizing in high-income regions is instead conducted inresource-poor settings. Twenty-eight case studies of ethics dumping were examined through inductive thematic analysis to reveal predisposing factors from the perspective of researchers from high-income regions. Six categories were agreed and further illuminated: Patronizing conduct, unfair distribution of benefits and/or burdens, culturally inappropriate conduct, double standards, lack of due diligence and lack of transparency. The ultimate aim of the paper is to deepen understanding of thesehighly unethical practicesamongst academics who stand against poverty, leading to theirfurther reduction.

Ethics dumping is the practice of undertaking research in a low- or middle-income setting which would not be permitted, or would be severely restricted, in a high-income setting. Whilst Kenya operates a sophisticated research governance system, resource constraints and the relatively low number of accredited research ethics committees limit the capacity for ensuring ethical compliance. As a result, Kenya has been experiencing cases of ethics dumping. This article presents 11 challenges in the context of preventing ethics dumping in Kenya, namely variations in governance standards, resistance to double ethics review, resource constraints, unresolved issues in the management of biological samples, unresolved issues in the management of primary data, unsuitable informed consent procedures, cultural insensitivity, differing standards of care, reluctance to provide feedback to research communities, power differentials which facilitate the exploitation of local researchers and lack of local relevance and/or affordability of the resultant products. A reflective approach for researchers, built around the values of fairness, respect, care and honesty, is presented as a means of taking shared responsibility for preventing ethics dumping.

This open access book offers insights into the development of the ground-breaking Global Code of Conduct for Research in Resource-Poor Settings (GCC) and the San Code of Research Ethics. Using a new, intuitive moral framework predicated on fairness, respect, care and honesty, both codes target ethics dumping – the export of unethical research practices from a high-income setting to a lower- or middle-income setting. The book is a rich resource of information and argument for any research stakeholder who opposes double standards in research. It will be indispensable for applicants to European Union framework programmes, as the GCC is now a mandatory reference document for EU funding

An increase in the number of companies that publish corporate social responsibility (CSR) statements, and a rise in their ‘sustainability’ research, reflects a growing acceptance that broad ethical considerations are key for any type of company. However, little is known about how companies consider moral objectives for their research and development (R&D) activities, or the basis upon which these activities are chosen. This research involves qualitative investigation into Responsible Research and Innovation (RRI) in the Information and Communication Technology (ICT) industry, comprising 30 in-depth, pan-European interviews with key personnel in the industry, and focus groups with employees at 14 different companies. Through investigation of the ‘responsible’ activities these companies currently undertake, we shed light on the types of moral goals they set and their underlying ethical standpoints. By reviewing both the responsible innovation and sustainability discourses, and presenting phenomenological evidence, we demonstrate that companies have adopted some aspects of RRI, even though it might not be recognised as such. Our findings indicate that these innovators recognise some of the ethical and societal concerns associated with their activities but their approach is often piecemeal; primary focus is upon the most immediate issues and on legal compliance, to the detriment of broader societal issues and wider challenges. We recommend explicit mechanisms that draw upon established ethical thought and practical academic work to improve companies' abilities to carry out their sustainability activities, and incorporate them into a responsible business strategy. We conclude with recommendations for innovators, corporate research and development, and policy.

Cross-sectorial, dynamic, and innovative partnerships are essential to resolve the challenges of humankind in the 21st century. At the same time, trust in each other’s integrity and good will is a precondition for the solution of any complex problem, and certainly for the success of the United Nations Sustainable Development Agenda. Experience shows that a nation’s economic and social success is at its greatest if, and when, there is cooperation and even cocreation involving a fair division of labor and responsibility among the different societal stakeholders. This paper uses Ralf Dahrendorf’s seminal work on obligations, as well as the European Commission’s Science with and for Society unit’s definition of responsible research and innovation (RRI), to motivate industry responsibilities to make the world a healthier place.

This book provides a systematic analysis of the ethical implications of traditional and complementary medicine, focusing on pragmatic solutions. The author uses a bioethical methodology called the “Ethical Matrix,” to consider the impact of T&CM use for animals and the environment as well as for humans. A systematic search of the literature reveals that most published ethical concerns are related to the safety of T&CM use for humans. However, application of the Ethical Matrix demonstrates that the ethical implications for T&CM use are much broader. In this book, the author analyses the most serious implications, including adverse events related to homeopathy, the use of animals in T&CM products, and the impact of herbal medicine on the environment. Comparisons with the ethical implications of conventional biomedicine help readers to contextualise debate, and highlight aspects that may be unique to T&CM. Globally, many high-level health policy makers promote T&CM as an accessible and affordable healthcare option. However, their use is considered by some to be a waste of resources, unscientific, and unethical. Offering a frank analysis of this largely ignored field of healthcare ethics, this book is both timely and essential. It helps patients, policy makers, practitioners, researchers, and students gain the knowledge they need to make more informed decisions.

The use of non-human primates in biomedical research is a contentious issue that raises serious ethical and practical concerns. In the European Union, where regulations on their use are very tight, the number of non-human primates used in research has been in decline over the past decade. However, this decline has been paralleled by an increase in numbers used elsewhere in the world, with less regard for some of the ethical issues (e.g. genetic manipulations). There is evidence that researchers from high-income countries (HICs), where regulations on the use of non-human primates are strict, may be tempted to conduct some of their experiments in countries where regulation is less strict, through new collaborative efforts. In collaborative ventures, equivalence in the application of ethical standards in animal research, regardless of location, is necessary to avoid this exploitation.

All forms of health care are associated with ethical challenges. This chapter briefly summarises an endeavour to identify, analyse and make recommendations for addressing challenges that are associated with traditional and complementary medicine (T&CM). This necessitated careful consideration from multiple perspectives, reflection upon what ‘health’ means and comparisons with conventional biomedicine. For many, T&CMs can be regarded as a key component of their ‘resilience toolkit’; when health is threatened, use of T&CMs can help people to respond positively.

A healthy environment is essential for human (and animal) health. The delivery of healthcare services can have highly detrimental environmental impacts. For instance, the production, transport and storage of medicines may contribute to the depletion of natural resources and, at the same time, accelerate pollution of the environment with by-products and waste materials. Thus, health care that is intended to keep humans and animals healthy also contributes to ill-health. Given the burgeoning need to make health care more sustainable, the impact of T&CM, specifically herbal medicine, upon the environment is examined. Recommendations are given on how harm to the environment can be avoided and/or minimised. Since the wellbeing of the environment is intricately linked to the health of living organisms, an examination of the relationship between the environment and health is included.

Critics of traditional and complementary medicine assert that people are putting their trust in the hands of incompetent and poorly regulated practitioners who are deliberately misleading patients about benefits leading to risks to health, and even lives. Injury or infection from acupuncture needles, severe injuries from osteopathy or chiropractic manipulation, or rejection of effective conventional medicine, are just some of the threats described for humans who use traditional and complementary medicine. The two most commonly cited safety concerns are examined: adverse drug reactions from herbal medicine and the potential for harm from delayed access to conventional care when using homeopathy. Through examination of real world scenarios and data, discrepancy between the rhetoric and the reality of these contentious issues is revealed.

‘Complementary’, ‘alternative’, ‘traditional’ or even ‘pseudomedicine’, are just some of the words that are used to describe this body of therapeutic interventions. Collectively, these terms evoke an array of seemingly disparate connotations, indicative of a wide range of perspectives. Indeed, opinions about their worth span a full spectrum from: ‘essential and highly valued forms of health care’, to: ‘no better than placebos that are proffered by charlatans’. This polarisation of perspectives is a significant challenge when it comes to explanation of what is meant by ‘complementary’ or ‘traditional’ medicine, as is the broad range of individual interventions that fall under this sizeable umbrella. The challenges for establishing a clear definition are explained and arguments given for adopting the World Health Organization’s definition of ‘traditional and complementary medicine’ (T&CM). An overview of the controversial nature of the subject matter provides a backdrop to subsequent ethical analysis in later chapters.

Ethical challenges to the use of T&CM are wide-ranging. The vast majority of published concerns are associated with the potential for harm to human users but there are also concerns for the wellbeing of animals and the environment. The ethical matrix is a bioethical methodology that has proven value across a number of disciplines to aid identification and analysis of ethical issues. Its use entails the mapping of ethical challenges against the applied ethical principles of wellbeing, autonomy and justice. Using the ethical matrix, ethical challenges related to T&CM are identified. Following completion of the matrix, the full extent of ethical issues relating to humans, animals and the environment becomes evident.

Unless we have a shared understanding of what health means, and what health looks like, we cannot agree upon what is needed to achieve it. However, the most commonly cited definition, that of the World Health Organization, has been subjected to a barrage of criticism because it is allegedly outdated and impossible to operationalise. More recent interpretations are aligned with concepts such as adaption, resilience and salutogenesis. As possibly the healthiest people in the world, the people of Okinawa in Japan have much to teach us about the qualities that are essential for health and wellbeing. Through examination of these illuminating topics, the meaning of health is described.