Abstract
Henry Richardson recently published the first book ever devoted to ancillary care obligations, which roughly concern what medical researchers are morally required to provide to participants beyond what safety requires. In it, Richardson notes that he is presenting the ‘only fully elaborated view out there’ on this topic, which he calls the ‘partial-entrustment model’. In this article, I provide a new theory of ancillary care obligations, one that is grounded on ideals of communion salient in the African philosophical tradition and that is intended to rival and surpass Richardson’s model, which is a function of Western considerations of autonomy. I argue that the relational approach of the former has several virtues in comparison to the basic individualism of the latter.
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Notes
Hence, this account of the nature of ancillary care obligations assumes from the start, with Richardson, that they are not merely obligations of general beneficence, the approach that had been deemed most promising by some in early discussions more than ten years ago [4].
Hence, this account of the nature of ancillary care obligations assumes from the start, with Richardson, that they do not merely ‘arise from implicit and explicit commitments, such as promises and roles’ that have been taken on with the expectation of providing aid, as per some others in the recent debate [5, p. 153].
I first briefly suggested this reasoning in [2, pp. 55–57], but do much more to spell it out and defend it here. It would be interesting to compare my approach with another relational account that Nate Olson has recently advanced [18], according to which the concept of respect for meaning in people’s lives as it inheres in their relationships is key.
A fuller account would require a theory of what is good for a human being, which I lack the space to provide here. However, I note that in the African tradition, the human good is usually conceived objectively, i.e., in terms of needs and not so much pleasant experiences or satisfied desires. A need-based theory of the human good would provide the ultimate basis for evaluating an agent’s claim that a certain degree of sacrifice is too great.
A weaker objection is that Richardson overemphasizes the role of free and informed consent to conduct the study. Suppose researchers did not seek out such consent, or suppose they sought it out but actually failed to obtain it (unbeknownst to them). Even so, ancillary care obligations would still obtain. This is not a deep problem for Richardson, I believe, since he could say that the violation of autonomy imposes all the more responsibility on the researcher to make up for it. What really does the work in Richardson’s theory is not the giving of informed consent or a waiver of privacy, contra his phrasing [1, pp. 34–37, 65], but the taking of private information, whether consensually or not.
A stronger objection, but one already made in the literature, is that the partial-entrustment model is too narrow when it comes to ‘scope’, i.e., the range of aid that a researcher should be expected to provide. In particular, several have suggested that participant conditions known to the researcher prior to the study can warrant being treated no less than those discovered in the course of the study (e.g., [18]).
A third possible reply is to suggest that the duty to aid in the present case is not a special one, but rather, an instance of a duty to rescue.
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Acknowledgements
For oral comments on a talk based on this research, I thank participants at the Conference on Giving a Voice to African Thought in Medical Research Ethics hosted by the University of the Witwatersrand Steve Biko Centre for Bioethics in 2015. For written comments on a previous draft, I am grateful to Kevin Behrens, Henry Richardson, and an anonymous referee for Theoretical Medicine and Bioethics. Research for this article has been supported financially by the South African National Research Foundation (NRF), and any opinion, findings, conclusions, or recommendations expressed in it are those of the author, with the NRF not accepting any liability in regard thereto.
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Metz, T. Ancillary care obligations in light of an African bioethic: from entrustment to communion. Theor Med Bioeth 38, 111–126 (2017). https://doi.org/10.1007/s11017-017-9404-1
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DOI: https://doi.org/10.1007/s11017-017-9404-1