本文關(guān)鍵詞： 跨國人體研究 剝削 全球正義　出處：《中山大學(xué)》2016年博士論文　論文類型：學(xué)位論文

【摘要】：隨著人體研究全球化的勃興,跨國人體研究中發(fā)展中國家人類受試者遭受濫用與剝削的隱憂引發(fā)社會關(guān)切�？鐕梭w研究具有三個特殊性:其一,跨國人體研究不一定滿足發(fā)展中國家的健康需要及優(yōu)先性設(shè)定;其二,風(fēng)險完全由發(fā)展中國家人類受試者承擔(dān);其三,研發(fā)成功產(chǎn)品可及性存在不確定性�；诎l(fā)展中國家缺乏完備的人體研究法規(guī)及有效的倫理審查機(jī)制,引發(fā)了安慰劑對照試驗中醫(yī)療照顧之雙重標(biāo)準(zhǔn)、知情同意實效性之質(zhì)疑以及試驗的公平受益等涉及剝削議題之持續(xù)二十多年的激戰(zhàn)與論辯。當(dāng)代北美生命倫理學(xué)者對于跨國人體研究剝削議題的探討成果較為豐碩,本研究首先重點解讀了其中五位重要代表人物的剝削觀及立場。艾倫?沃特海默在粗略的剝削定義基礎(chǔ)上,依據(jù)被剝削者是否受益區(qū)分傷害性剝削與互利性剝削;依據(jù)被剝削者同意與否劃分同意式剝削與非同意式剝削,其認(rèn)為應(yīng)當(dāng)禁止傷害性、非同意式剝削;然而,當(dāng)跨國人體研究屬于同意互利式剝削應(yīng)得到允許。安吉拉?巴蘭廷則對艾倫的結(jié)論進(jìn)行限制,提供了一個以評估剝削強(qiáng)度的互利式交易分析框架,旨在探討減少而非完全消除互利性交易中的剝削。詹妮弗?霍金斯基于批駁研究者義務(wù)之醫(yī)學(xué)模型,認(rèn)為研究者沒有為受試者提供最佳醫(yī)療照顧的義務(wù),僅具有一個好撒馬利亞人之不完全義務(wù)。當(dāng)未履行該義務(wù)時,構(gòu)成了一種非傷害性剝削。安德魯?西格爾基于康德主義,認(rèn)為跨國人體研究存在三種剝削形式,其一,涉及破壞或干擾人類理性能力的剝削,即知情同意有效性相關(guān)的剝削;其二,對人格尊嚴(yán)貶損式剝削,通常源自于試驗申辦者與試驗受試者之間貧富差距與權(quán)力上的不平等;其三,涉及到侵犯行善義務(wù)的剝削。第三種剝削是跨國人體研究中最為普遍的剝削形式,侵犯行善義務(wù)存在兩種道德錯誤:剝削與冷漠。剝削表現(xiàn)為A對B的基本需要漠不關(guān)心的同時,利用B的不利處境進(jìn)行交易并從中受益。有些跨國人體研究不僅對東道國民眾緊迫健康需要無動于衷而且獲益于這種不利處境時構(gòu)成剝削。有些跨國人體研究雖未構(gòu)成剝削但卻冷漠對待東道國民眾緊迫的健康需要。露絲?麥克林基于脆弱性的剝削觀,對跨國人體研究中可能涉及剝削的五種代表性情況進(jìn)行了分析,強(qiáng)調(diào)了在預(yù)防、減少和避免剝削中,發(fā)展中國家的自主能動性的作用�；隈R克思主義理論視角對北美學(xué)者觀點的優(yōu)勢與限度進(jìn)行了總體評判,雖然北美學(xué)者皆持非馬克思主義的剝削觀與程度不一的可允許剝削立場,其中最為極端的是沃特海默的立場。北美學(xué)者觀點的根本缺陷在于聚焦微觀分析,限于交換領(lǐng)域與交換正義等。本研究提出馬克思式可允許剝削觀:基于當(dāng)前發(fā)展中國家生產(chǎn)力的發(fā)展?fàn)顩r和發(fā)展水平,在全面慎思考量下,允許為了公民更為重要的人權(quán)利益、滿足國家健康需要的自愿互利式剝削。然而,解放全人類,追求人類全面自由發(fā)展的馬克思主義有著強(qiáng)大的批判精神與進(jìn)取精神,消除剝削是必然目標(biāo)。針對這一議題,本研究分析了北美學(xué)者們應(yīng)對跨國人體研究剝削的解決思路及策略。伊曼紐爾等駁斥了合理可及性要求,訴諸寬泛利益觀與發(fā)展中國家自主權(quán),提出公平利益框架(公平利益、合作伙伴關(guān)系與透明性三原則);約翰?蘭登教授則在對公平利益框架的精辟駁斥下,提出人類發(fā)展路徑;安吉拉?巴蘭廷重視與關(guān)切發(fā)展中國家貧困群體的基本需要,提出最大最小化原則與國際人體研究稅的策略;濤慕思?博格基于全球正義理論的高度提出遠(yuǎn)見卓識的創(chuàng)新策略——健康影響力基金。這些見解啟發(fā)我們,對于跨國人體研究倫理爭論本質(zhì)是全球秩序不公正所造成發(fā)達(dá)國家與發(fā)展中國家健康不平等的又一體現(xiàn),需要尋求全球正義理論的指導(dǎo)。最后,從治理的視角出發(fā),闡明跨國人體研究治理與全球健康治理的內(nèi)在聯(lián)系,指出跨國人體研究治理的目標(biāo)——跨國人體研究應(yīng)當(dāng)為全人類健康服務(wù),而非僅為世界上少數(shù)發(fā)達(dá)國家及其富裕公民健康服務(wù)。以全球治理與國家治理的良性互動之實踐路徑,邁向更為公平公正的跨國人體研究。
[Abstract]:With the globalization of human research development of transnational human studies in developing human subjects suffering from abuse and exploitation caused worries to social concerns. Transnational human research has three characteristics: first, transnational human studies do not necessarily meet the health needs of the developing countries and priority setting; second, the risk of developing countries by human subjects bear third, there is uncertainty; the successful development of product availability. Lack of complete and effective regulations of human research ethics review mechanism based on developing countries, triggered a placebo-controlled trial of double standards in medical care, informed consent of the effectiveness of questioning and trial involving the exploitation of fair benefit issues for more than 20 years of fighting and debate to investigate the results of human studies. For transnational exploitation issues of contemporary North American bioethics scholar fruitful, the research first To focus on the interpretation of the five important representatives of the view and exploitation position. Alan? Voight's definition based on the exploitation in the rough, on the basis of the exploited are the benefits of sexual exploitation and mutual harm distinguish sexual exploitation; exploited according to agree or not agree to divide type of exploitation and without the consent of the type of exploitation, the prohibition of damage should be, without the consent of type exploitation; however, when transnational human research belongs to the type of exploitation should be allowed to benefit. Angela? Restrictions on Alan Baran Argentina provides a conclusion, to assess the strength of mutually beneficial trade exploitation framework aims to reduce rather than eliminate beneficial transactions in the exploitation Jennifer? Hawkins medical researchers criticize obligation model based on that the researchers did not provide the best medical care obligations as subjects, only to have a good Samaritan incomplete meaning Wu. When did not fulfill the obligations, constitute a non damaging exploitation. Andrew Seagal? Based on Kantian, multinational human studies there are three forms of exploitation, one involving damage or interfere with human rational ability exploitation, that informed consent is the effectiveness of exploitation; second, the dignity of derogatory type of exploitation, usually between the applicant and the test from the test subjects and the gap between the rich and the poor power inequality; thirdly, involving violations of the obligations of good exploitation. Third kinds of exploitation is the most common form of transnational exploitation in human studies, there are two kinds of moral obligation violation of good error: exploitation and exploitation show indifference. A is indifferent basic needs for B at the same time, to benefit from trading with adverse situation of B. Some transnational human studies not only on the host country people urgent health needs and benefit from this completely indifferent Unfavorable situation of transnational exploitation. Some human studies did not constitute exploitation but indifference to the host country people urgent health needs. Ruth? Mclean vulnerability exploitation based on the concept of five representative cases may involve the exploitation of transnational human studies are analyzed, emphasis on prevention, reduce and avoid exploitation in developing countries, the initiative role. Advantages and limitations from the perspective of Marx theory on the North American scholars view based on the overall evaluation, although North American scholars hold non Marx's view and the exploitation degree is not an allowable exploitation position, one of the most extreme is Voight's stance is to focus on the micro. Analysis of fundamental flaws in North American scholars point of view, to exchange and exchange field of justice. This study proposes Marx can be allowed to exploit view: the current production based on developing countries The development status and level of development in full force, think carefully about the amount, in order to allow citizens more important human rights and interests, to meet the health needs of the national voluntary benefit type exploitation. However, the liberation of all mankind, the pursuit of human freedom and all-round development of the Marx doctrine has a strong critical spirit and enterprising spirit, the elimination of exploitation is inevitable objective. To solve this issue, this study analyzes the solutions and Strategies of North American scholars dealing with transnational human research exploitation. Emanuel refuted the reasonable accessibility requirements, resorting to the broad view of interests and developing autonomy, puts forward the equity interest framework (equity interests, partnerships and transparency principle; three) John? Professor Landon in the refutation of fair interest framework incisive, put forward human development path; BA LAN Ting Angela? Attention and concern the basic needs of poverty in developing countries,. The maximum and minimum principle and Research on international human tax policy; Tao mousse? Berg global justice theory based on the height of the proposed innovation -- the health impact fund strategy. These visionary insight inspires us for transnational human research ethics debate is the essence of the global order of injustice caused by the developed countries and the developing countries health inequality reflects another the need for global justice, the guidance of the theory. Finally, from the perspective of governance, relationship governance and transnational human studies to clarify the global health governance, pointed out that the goal of transnational human research governance: transnational human studies should be for human health services, not only a few of the world's developed countries and health services to wealthy citizens. The interaction between the practice path of global governance and national governance, transnational human studies towards a more fair.

【學(xué)位授予單位】：中山大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：B82-0
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本文編號：1539115