Philosophy Ethicals

Patricia King “The Dangers of Difference” * The Dilemma of Difference * Even when a study purports to be helping a disadvantaged group it may cause harm * If the racial difference is ignored harm can result from ignoring factors that may have a correlation with race. Patricia King “The Dangers of Difference” * Inclusion/Exclusion * Inclusion: required that vulnerable groups be protected, e.g. equitable selection, cognizant of specific problems with respect to vulnerable groups * Exclusion: Too much protection might result in the underrepresentation of vulnerable groups.
Patricia King “The Dangers of Difference” * Three reasons for increasing representation of African Americans in clinical trials: 1. There may be biological differences between blacks and whites which would affect the applicability of the findings 2. Race can be a reliable index for certain social conditions e.g. nutrition, access to health care, socioeconomic factors 3. The burdens and benefits of research should be spread among the population regardless of race or ethnicity
Patricia King “The Dangers of Difference” * How can we advocate for increased participation of minorities in clinical research and minimize the harms that may come from this participation? * Start with the presumption that blacks and whites are biologically the same * Priority should be given to exploring social, cultural, and environmental determinants of disease BEFORE biological hypotheses are studied * If there does turn out to be a biological difference this does not necessitate a hierarchical view of race or to discrimination * Mastroianni and Kahn “Swinging on the Pendulum” * Problems w. “protection” * E.g. prisoners wanted to participate in clinical trials * $, Access to better/more frequent health care, believed they were making a contribution to society * However, protection policies precluded prisoners from