Resnik David B
National Institute of Environmental Health Sciences, National Institutes of Health, Box 12233, Mail Drop CU 03, Research Triangle Park, NC, 27709, USA,
Med Health Care Philos. 2015 Feb;18(1):23-32. doi: 10.1007/s11019-014-9569-6.
Unequal treatment of human research subjects is a significant ethical concern, because justice in research involving human subjects requires equal protection of rights and equal protection from harm and exploitation. Disputes sometimes arise concerning the issue of unequal treatment of research subjects. Allegedly unequal treatment occurs when subjects are treated differently and there is a genuine dispute concerning the appropriateness of equal treatment. Patently unequal treatment occurs when subjects are treated differently and there is not a genuine dispute about the appropriateness of equal treatment. Allegedly unequal treatment will probably always occur in research with human subjects due to disagreements about fundamental questions of justice. The best way to deal with allegedly unequal treatment is to promote honest and open discussions of the issues at stake. Research regulations can help to minimize patently unequal treatment by providing rules for investigators, ethical review boards, institutions, and sponsors to follow. However, patently unequal treatment may still occur because the regulations are subject to interpretation. Federal agencies have provided interpretive guidance that can help promote consistent review and oversight of human subjects research. Additional direction may be needed on topics that are not adequately covered by current guidance or regulations. International guidelines can help promote equal treatment of human subjects around the globe. While minor variations in the treatment of research subjects should be tolerated and even welcomed, major ones (i.e. those that significantly impact human rights or welfare) should be avoided or minimized.
对人类研究对象的不平等对待是一个重大的伦理问题，因为涉及人类对象的研究中的公正要求平等保护权利以及平等保护免受伤害和剥削。关于研究对象不平等对待的问题有时会引发争议。当研究对象受到不同对待且对于平等对待的适当性存在真正争议时，就会出现所谓的不平等对待。当研究对象受到不同对待且对于平等对待的适当性不存在真正争议时，就会出现明显的不平等对待。由于在基本正义问题上存在分歧，所谓的不平等对待可能在涉及人类对象的研究中总是会出现。处理所谓不平等对待的最佳方式是推动对相关关键问题进行诚实且开放的讨论。研究法规可以通过为研究者、伦理审查委员会、机构和资助者提供遵循的规则，来帮助尽量减少明显的不平等对待。然而，明显的不平等对待仍可能发生，因为法规存在解释的空间。联邦机构已提供解释性指导，这有助于促进对人类对象研究进行一致的审查和监督。对于当前指导或法规未充分涵盖的主题，可能还需要更多的指导。国际准则有助于在全球范围内促进对人类研究对象的平等对待。虽然对研究对象的对待存在细微差异应予以容忍甚至欢迎，但重大差异（即那些对人权或福利有重大影响的差异）应避免或尽量减少。
