Página 230 - Dimensiones éticas de las regulaciones en salud

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health services are among the constituents of vulnerability; then the re-
duction of disparities should be seen as a goal of bioscientific inquiry. It
follows, then, that research ethics committees should be concerned about
whether their institutions’ protocols embrace or aim for this goal.
A number of new and interesting ethical challenges arise, not least among
them: What is to be done when individual members of groups we seek
to protect as vulnerable populations protest that the protections them-
selves are patronizing, harmful or perhaps even oppressive? How should
investigators and their institutions respond when authorities in a vulner-
able population take a position that is widely known to be dangerous or
atherapeutic? Does it matter if that leadership is itself based on sexual,
racial, class or other hierarchies?
It is the contention here that these challenges are as philosophical as they
are regulatory; probably moreso. If this is correct, it means that those who
by dint of interest or duty seek to protect vulnerable populations must
attend to the complex and sometimes contradictory forces at work. It just
will not do to attempt to replace ethical analysis with scrutiny of law or
regulation in hopes of finding a code or key that will point to the right
answer. Ethical algorithms, if such exist, might work for simple issues, but
they will be utterly useless in the face of the kinds of problems and chal-
lenges that face actual research in real-world settings.
In the case of vulnerable populations, these observations have another
virtue. When people of good will seek to learn more about the world
and hope thereby to improve the lot of people, and when some of these
inquiries are directed to populations heretofore oppressed, ignored or ne-
glected, then the members of such populations cannot be blamed if they
ask why, if researchers from that civilization or barrio or culture yonder
are so concerned about us, that we are vulnerable in the first place? How
(they might ask) has it come to pass that members of your dominant
population can actually advance your careers by studying us if it were not
at least in part because of your dominance that we are vulnerable?