Trading participation for access to health-care: A morally relevant feature of participation in clinical research

INSTITUTION: Department of Social Science, Health and Medicine, King’s College, London, UK. The increasing tendency to run clinical trials offshore in low- and middle-income countries (LMICs) has been extensively documented. In parallel, in high-income countries (HICs) as the US, we are witnessing the emergence of new forms of clinical research where un(der)insured fractions of the population are trading access for participation to health-care to which they would otherwise not have access. We first discuss Wertheimer’s analysis of offshored clinical trials as mutually advantageous exploitative transactions. We then argue that to make sense of what is morally problematic with the offshoring of clinical research it is necessary to broaden the ethical analysis, as there are different kinds of moral wrongs that can be linked to exploitation. We then further broaden our gaze beyond exploitation to analyse a distinct sort of moral wrong inherent in the off-shoring of clinical research, namely the sponsors’ complicity in perpetuating the injustice of the background conditions of the participants. We argue that both modes of participation in clinical research highlighted above share the feature of ‘trading participation for access to health-care’, and that this is a morally relevant characteristic that should be taken into consideration in the ethical analysis, and that in some cases justify intervention to prevent subjects from participating in clinical trials. We conclude that as health-care provision and clinical trial participation have been and continue to be strictly intertwined both in LMICs and in HICs, in both contexts, there is a need to devise ways to make the inclusion of economically disadvantaged and uninsured individuals in clinical research as fair as possible.