This Medical Ethics Case Study examines the ethical dilemmas surrounding clinical trials conducted on Haitian civilians, focusing on issues of informed consent, exploitation, and the duty to protect vulnerable populations. It explores the challenges in ensuring participants fully understand the ris...
1. Research and Medicine Haiti - (Research and Medicine Collide in Haiti)
A. A brief summary of the case under consideration (Gabby)
i. The case “Research and Medicine Collide in Haiti” seeks to determine the
ethics of using an impoverished population to further AIDS research. Cornell Medical
College runs an AIDS research clinic in Port-au-Prince, Haiti to study AIDS in cases
where only one sex partner has the disease in hopes to find a cure. Haitians are ideal
research subjects due to not receiving care that is standard in the rest of the world. In
Haiti, condom use is low and antiviral drugs are unavailable except for the very wealthy.
Throughout the study, participants continue to be exposed to the virus while the clinic
only promises to provide medical help in the case the participant is unable to afford it on
their own without the promise of antiretroviral drugs. Experts agree that if this research
were done in the United States, physicians would be obligated to prescribe antiretroviral
and counseling for participants. There are concerns that participants at the Haitian clinic
do not receive the same level of counseling and care as those in the United States. This
study has received scrutiny from officials in Washington due to the lack of treatment and
lack of information provided by the clinic in Haiti to its participants.
B. Ceniya:
i. In reviewing of this case, Aristotle’s framework emphasized the virtues of
justice, compassion, honesty, and practical wisdom. It’s not clear whether he would
agree with the clinical trials proceeding through Haiti, for the motivations of the
researchers and physicians involved in the trials that could be for personal benefit,
versus the community. Any medical trial should contribute to the overall flourishing of
both the researchers and the patients. If the trials exploit the impoverished patients
without consideration of their well-being or dignity, Aristotle would likely see a failure in
virtue ethics. It is not an act of practical wisdom if they ignore the specific needs and
vulnerability of the Haitian people. Key virtues like justice and compassion are deficient.
The patients in Haiti receive a lower standard of care than in developed nations, which
fails the virtue of equity. While the research is driven in a positive light (a vaccine), it
should not come at the cost of exploiting the weaker status of the population. The Role
of Virtue, the moral character of the researchers, is crucial. It would emphasize that good
intentions alone are not enough. The care given to the Haitian patients must reflect
practical wisdom in balancing research goals with the moral obligation to provide proper
care regardless of external circumstances.
i. Kant’s Deontological Ethics demanded the adherence to real principles,
especially the categorical imperative, which requires treating every person as an end.
Providing a lower standard of care to Haitian patients while using them as subjects
violates their duty to treat all individuals with equal dignity and respect; along with the
failure to provide antiretroviral drugs or proper protection, such as contraceptives. This is
seen as neglecting the patients’ worth and violating their autonomy. There is a potential
breach of the duty to ensure fully informed consent. If patients are not made aware of all
the risks, or the fact that they are receiving inferior care compared to developed nations,
their autonomy, is undermined. The ethics would condemn them to fail to respect their
rational capacity to make decisions.
, i. Utilitarianism Perspective, the ethical evaluation of AIDS and HIV trials on
impoverished patients in Haiti would depend on whether the research produces the
greater outcome for the majority of people. With weighed potential benefit of the trials,
such as finding effective treatment or vaccination, could save lives globally. This would
make a significant advancement in medicine, reducing the suffering of current and future
HIV/AIDS patients. However, for the trials to be ethical, the risks must be secured
without manipulation due to their economic situation. There needs to be a careful
balance to the potential long-term benefits of the research with the short-term harms
experienced by the patients. The fact that patients are exposed to preventable risks, and
do not receive the best possible care suggests a significant immediate harm that may
not be justified by the future benefits. It’s a question whether the long-term goals truly
justify the short-term harm and exploitation of a vulnerable population.
C. Stefano - Cornell University knowingly has a conflict of interest with in what data they want to
collect, and what to exploit in terms to receive that information. Why is this not being
investigated? The university has no interest in pursuing the problem because “they have other
studies that MUST be tended to”. We see the comparison of the Tuskegee study to this of
patients that have HIV and AIDS. Why do they not treat the people of Haiti the same way as
health care providers do in The America’s? Because it is mentioned that there is a lack of
informed consent. Rather partial informed consent, but that it is equal to as not having any at all.
We also observe a lack of confidentiality with said patient(s). One statement brought up by one
of the present physicians was,“ Offering the drug is an unethical lure for participation”. Well, if
that's the case, why is it being perceived as a “Faustian Bargan?” If the solution is unethical,
why is it being offered in the first place? Which brings back the notion of exploitation of research
for the sole purpose of collecting data, and test subject that are far more than willing to
participate if lied to.
D. Lanie
E. Jacob: The case study of research and medicine in Haiti is critiqued as unfair and unjust for
those that are living in the impoverished country of Haiti. We have declared a decision not on
opinions but by analyzing how the theories of Aristotle and Kant would have played a role in the
judgment of the clinic and how they acted upon patients in search for better medicine. Not only
Aristotle and Kant but also looked into the utilitarian perspective. The Utilitarian perspective
disagreed with the practice even though it weighs the overall good versus the overall bad and
the overall good is favored the majority of time.
F. Claire: Is the education of the impoverished area involved in the studies a contributing reason
to why these types of medical research groups target these areas? What are other powers
possibly involved that allow for this type of research to keep happening? The group's
conclusions are Aristotle would not approve of the process, and it goes against some of his key
beliefs. He would see it as failure of virtue, justice, and compassion towards those who are
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