title: Codes of medical ethics and the exportation of less-than-standard care.
abstract: Recently a number of AIDS/AZT research studies, carried out by U.S. universities, have come under intense ethical scrutiny. In these studies, control groups of HIV-positive pregnant women were being given a placebo rather than AZT. Such research protocols would be illegal if practiced in the U.S. I examine a number of lamentable ethical lapses in the studies, and conclude that at least some of these ethical problems are traceable to a troubling contradiction between differing international codes of ethics. In a word, some international codes mandate that all research subjects (including control groups) receive the best standard of care available in the country sponsoring the research, while others suggest that providing only a "local" standard of care is ethically appropriate. I argue that these two ethical mandates cannot both be satisfied, and that host country populations will remain subject to exploitation unless this contradiction is resolved.
authors.affiliation: University of Massachusetts, Dartmouth, USA.
authors.forename: P
authors.initials: P
authors.lastname: Cox
mesh_terms: D032781:Codes of Ethics; D019049:Developed Countries; D003906:Developing Countries; D034723:Double Effect Principle; D026689:Ethical Analysis; D032984:Ethics, Research; D005260:Female; D017408:Guidelines as Topic; D015658:HIV Infections / Q000517:prevention & control* / Q000628:therapy*; D006805:Human Experimentation; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007258:Informed Consent; D038622:Internationality; D010919:Placebos; D011247:Pregnancy; D037841:Pregnant People; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D012107:Research Design / Q000592:standards; D015215:Zidovudine / Q000627:therapeutic use*
chemical_list: D010919:Placebos; D015215:Zidovudine