探索全球卫生研究重点设定的伦理问题。
Exploring the ethics of global health research priority-setting.
作者信息
Pratt Bridget, Sheehan Mark, Barsdorf Nicola, Hyder Adnan A
机构信息
Nossal Institute for Global Health and Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie St Street, Carlton, VIC, 3053, Australia.
Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
出版信息
BMC Med Ethics. 2018 Dec 6;19(1):94. doi: 10.1186/s12910-018-0333-y.
BACKGROUND
Thus far, little work in bioethics has specifically focused on global health research priority-setting. Yet features of global health research priority-setting raise ethical considerations and concerns related to health justice. For example, such processes are often exclusively disease-driven, meaning they rely heavily on burden of disease considerations. They, therefore, tend to undervalue non-biomedical research topics, which have been identified as essential to helping reduce health disparities. In recognition of these ethical concerns and the limited scholarship and dialogue addressing them, we convened an international workshop in September 2015. The workshop aimed to initiate discussion on the appropriate relationship between global and national levels of health research priority-setting and to begin exploring what might be ethically required for priority-setting at each of those levels.
MAIN TEXT
This paper comprises our reflections following the workshop. Its main objective is to launch a research agenda for the ethics of global health research priority-setting. We identify three domains of global health research priority-setting-scope, underlying values and substantive requirements, and procedural considerations. For each domain, specific research questions are highlighted and why they need to be explored is explained. Some preliminary thoughts and normative arguments as to how the research questions might be answered are also offered. For example, we provide initial ideas about the appropriate relationship between different priority-setting levels and what values and substantive considerations should guide or underpin global health research priority-setting as a matter of justice.
CONCLUSION
We anticipate that framing a new research agenda for the ethics of global health research priority-setting will spur ethicists, researchers, and policymakers to refocus their efforts on developing more rigorous and ethically sound approaches to priority-setting.
背景
到目前为止，生物伦理学领域中专门针对全球卫生研究重点确定的工作很少。然而，全球卫生研究重点确定的特点引发了与卫生公平相关的伦理考量和担忧。例如，此类过程往往完全由疾病驱动，这意味着它们严重依赖疾病负担方面的考量。因此，它们往往低估了非生物医学研究主题，而这些主题已被确定为有助于减少卫生差距的关键。认识到这些伦理问题以及针对这些问题的学术研究和对话有限，我们于2015年9月召开了一次国际研讨会。该研讨会旨在启动关于全球和国家层面卫生研究重点确定之间适当关系的讨论，并开始探讨在每个层面进行重点确定在伦理上可能需要些什么。
正文
本文包含我们在研讨会之后的思考。其主要目标是启动一项关于全球卫生研究重点确定伦理的研究议程。我们确定了全球卫生研究重点确定的三个领域——范围、基本价值观和实质性要求以及程序考量。针对每个领域，突出了具体的研究问题，并解释了为何需要对其进行探讨。还提供了一些关于如何回答这些研究问题的初步想法和规范性论点。例如，我们就不同重点确定层面之间的适当关系以及作为公平问题，哪些价值观和实质性考量应指导或支撑全球卫生研究重点确定提供了初步想法。
结论
我们预计，为全球卫生研究重点确定伦理制定一个新的研究议程将促使伦理学家、研究人员和政策制定者重新将精力集中在开发更严谨且符合伦理的重点确定方法上。
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