Hill Peter
Australian Centre for International & Tropical Health & Nutrition, The University of Queensland, Herston, Australia.
Dev World Bioeth. 2004 Dec;4(2):139-53. doi: 10.1111/j.1471-8731.2004.00089.x.
Although considerable attention has been given to ethical issues related to clinical research in developing countries, in particular related to HIV therapy, there has been limited focus on health systems research, despite its increasing importance in the light of current trends in development assistance. This paper examines ethical issues related to health systems research in 'post'-conflict situations, addressing both generic issues for developing countries and those issues specific to 'post'-conflict societies, citing examples from the author's Cambodian experience. It argues that the destruction of health infrastructure results in a loss of structures and processes that would otherwise protect prospective research subjects who are part of vulnerable populations. It identifies the growth of health systems research as part of a trend towards sectoral and programmatic development assistance, the emergence of 'knowledge generation' as a form of research linked to development, and the potential for conflict where multilateral and bilateral donors are both primary funders and users of health systems research. It also examines the position of the health system researcher in relation to the sponsors of this research, and the health system being analysed.
尽管发展中国家临床研究相关的伦理问题已受到相当多关注，尤其是与艾滋病毒治疗相关的问题，但卫生系统研究却较少受到关注，尽管鉴于当前发展援助趋势其重要性日益凸显。本文探讨冲突“后”局势下卫生系统研究的伦理问题，既涉及发展中国家的一般性问题，也涉及冲突“后”社会特有的问题，并援引作者在柬埔寨的经历为例。文章认为，卫生基础设施的破坏导致原本可保护弱势群体中潜在研究对象的结构和程序丧失。它指出卫生系统研究的增长是部门和方案发展援助趋势的一部分，“知识生成”作为与发展相关的一种研究形式的出现，以及多边和双边捐助方既是卫生系统研究的主要资助者又是使用者时可能产生的冲突。它还审视了卫生系统研究人员相对于该研究资助方以及所分析的卫生系统的立场。
