An Ethical Framework for Global Governance for Health Research

Global Governance is the way by which various affairs of human social life at the global scale are governed in the absence of a global governance. This field is composed of complex networks of role players. Global Health Governance is a branch of Global Governance that governs the health-related affairs. An important branch of this huge complex of networks that has not been analyzed sufficiently in the scholarly literature yet is Global Governance for Health Research. Global health research, although it is a part of global health affairs, has its own features and conditions that bring about its specific issues and challenges at the global scale. Therefore, Global Governance for Health Research, although is generally a part of Global Health Governance, has major differences (along with similarities and overlaps) with it in different aspect, including the major role-players, ethical authorities and institutions, and the main issues and challenges. This dissertation classifies the major role players of Global Governance for Health Research into the state and non-state role players. The major state role-players of Global Health Governance are intergovernmental organizations such as the World Health Organization (WHO), the World Bank, and UNESCO. The non-state organizations include the World Medical Association (WMA) and numerous other civil society and philanthropic organizations and corporations. The WHO and the World Bank, although important in the realm of global research, have not been the most influential role-payers in Global Governance for Health Research. Since the Global Governance for Health Research has mainly been materialized through internationally recognized frameworks and guidelines, the organizations that created, adopted, and promulgated these instruments have been the most influential role-players in the realm of Global Governance for Health Research, among them being the UNESCO, WMA, and CIOMS. Global Governance for Health Research has its own challenges that are discussed in chapter 3 and studied through cases in chapter 4 of this dissertation. Challenges such as exploitation and helicopter research, double standards, bilateralism, the impact of bio-politics, ethical imperialism and colonialism, and the problem of data sharing and big data. The framework of gaps is also relevant to this field and the knowledge, normative, policy, institutional, and compliance gaps show themselves in Global Governance for Health Research. The cases discussed in this dissertation include the Zika Pandemic, the Research integrity in Iran, HIV/AIDS Research in Africa, Sending Biological Specimens Abroad (the problem of Bio-piracy), Research on Pre-Implantation Human Embryo, and Local and International Alternative Medicines. Each of these cases portrays a specific set of challenges and gaps in the current situation of Global Governance for Health Research. In addition, it has been shown that most of the challenges in this area are of ethical nature. Therefore, there is a need to a systematic and comprehensive ethical framework in this arena. This dissertation suggests an ethical framework for Global Governance for Health Research that is composed of three main elements. A virtue-based element/layer that encompasses three moral virtues of empathy, compassion, and care. These virtues are the most basic moral attributes of physicians/health researchers and underlie their ethical behavior and their compliance to the principles. A two-layered principle-based element that encompasses a layer of fundamental principles, i.e. Human Dignity, Human Rights, and Non-Exploitation and a layer of more specific or practical principles that mostly adopted from the UNESCO Declaration of Bioethics and Human Rights to have a comprehensive and universal approach and from the NIH framework to have a research-oriented systematic approach. And the last element of the suggested framework is inspired by particularism or situation ethics that demands establishing, empowering, and strengthening networks of oversight and review committees/boards to guarantee the continual and comprehensive case-by-case ethical review and oversight and monitoring all over the gigantic networks involved in global health research enterprise. Despite the existing challenging trends such as neoliberalism, isolationism, and protectionism in the Western countries and fundamentalism in some developing countries it seems that the suggested framework can be helpful in shedding ethical light on the challenges of Global Governance for Health Research and in filling its various gaps. This study is a small step in filling the knowledge gap. The suggested framework can fill part of the normative gap, this framework can be an ethical basis for policies that may fill the policy gap, the situation-ethics element of the framework is concerning the necessity and the ethical way for filling the institutional gap and finally, removing or alleviating the moral barriers is one of the ways for filling the compliance gap. Filling these gaps is not a one-time mission, instead, the process of developing and filling these gaps is continuous and will continue as long as the Global Governance for Health research is a reality on the global scene. In the final part of this dissertation, a number of practical and research recommendations and suggestions are provided

Iran's Experience on Religious Bioethics: an Overview

Asian Bioethics Review14318-32

History of attitudes toward death: a comparative study between Persian and western cultures

In his seminal book on the historical periods of Western attitudes toward death, Philippe Aries describes four consecutive periods through which these attitudes evolved and transformed. According to him, the historical attitudes of Western cultures have passed through four major parts described above: Tamed Death, One\u27s Own Death, Thy Death, and Forbidden Death. This paper, after exploring this concept through the lens of Persian Poetic Wisdom, concludes that he historical attitudes of Persian-speaking people toward death have generally passed through two major periods. The first period is an amalgamation of Aries\u27 Tamed Death and One\u27s Own Death periods, and the second period is an amalgamation of Aries\u27 Thy Death and Forbidden Death periods. This paper explores the main differences and similarities of these two historical trends through a comparative review of the consecutive historical periods of attitudes toward death between the Western and Persian civilizations/cultures. Although both civilizations moved through broadly similar stages, some influential contextual factors have been very influential in shaping noteworthy differences between them. The concepts of after-death judgment and redemption/downfall dichotomy and practices like deathbed rituals and their evolution after enlightenment and modernity are almost common between the above two broad traditions. The chronology of events and some aspects of conceptual evolutions (such as the lack of the account of permanent death of nonbelievers in the Persian tradition) and ritualistic practices (such as the status of the tombs of Shiite Imams and the absolute lack of embalming and wake in the Persian/Shiite culture) are among the differences

The Ownership of Human Body: An Islamic Perspective

Using human dead body for medical purposes is a common practice in medical schools and hospitals throughout the world. Iran, as an Islamic country is not an exception. According to the Islamic view, the body, like the soul, is a "gift" from God; therefore, human being does not possess absolute ownership on his or her body. But, the ownership of human beings on their bodies can be described as a kind of "stewardship". Accordingly, any kind of dissection or mutilation of the corpse is forbidden, even with the informed consent of the dead or his/her relatives. The exception of this principle is when such procedures are necessary for saving lives of other persons. In this article using the human dead body for medical education, research and treatment is discussed and the perspective of Iranian Shiite religious scholars in this regard is explained

Compassion as the reunion of feminine and masculine virtues in medicine

The central role of the virtue of compassion in the shaping of the professional character of healthcare providers is a well-emphasized fact. On the other hand, the utmost obligation of physicians is to alleviate or eliminate human suffering. Traditionally, according to the Aristotelian understanding of virtues and virtue ethics, human virtues have been associated with masculinity. In recent decades, the founders of the ethics of care have introduced a set of virtues with feminine nature. This paper analyzes the notion of compassion as a common virtue between the traditional/masculine and care/feminine sets of virtues and shows that compassion is a reunion and merging point of both sets of human virtues. This role can be actualized through the development and promotion of compassion as an important part of the character of an ideal physician/healthcare provider. In addition, this paper argues that the notion of compassion can shed light on some important aspects of the contemporary debates on healthcare provider-patient relationship and medical futility. Despite the recent technological and scientific transformations in medicine, the interpersonal relationship between healthcare providers and patients still plays a vital role in pursuing the goals of healthcare. The virtue of compassion plays a central role in the establishment of a trust-based physician-patient relationship. This central role is discernible in the debate of medical futility in which making difficult decisions, depends largely on trust and rapport which are achievable by compassion in the physician and the recognition of this compassion by the patients and their surrogate decision makers

Attitude toward Plagiarism among Iranian Medical Faculty Members

The goal of this study was to assess attitude towards plagiarism in faculty members of Medical School at Tehran University of Medical Sciences. One hundred and twenty medical faculty members ofTehran University of Medical Sciences were enrolled in this cross-sectional study. They were asked to answer to valid and reliable Persian version of attitude towards plagiarism questionnaire. Attitude toward plagiarism, positive attitude toward self-plagiarism and plagiarism acceptance were assessed. Eighty seven filled-up questionnaires were collected. Mean total number of correct answers was 11.6 ± 3.1. Mean number of correct answers to questions evaluating self-plagiarism was 1.7 ± 0.4 and mean number of correct answers to questions evaluating plagiarism acceptance was 1.4 ± 0.2. There was no significant correlation between plagiarism acceptance and self-plagiarism (r=0.17, P=0.1). It is essential to provide materials (such as workshops, leaflets and mandatory courses) to make Iranian medical faculty members familiar with medicalresearch ethics issues such as plagiarism

Measuring professionalism in residency training programs in Iran

Background and aim: To assess the Farsi (Persian) translated and modified version of the questionnaire of the American Board of Internal Medicine (ABIM) for measuring professionalism, and also, measuring the professional attitudes and behaviors associated with the medical residency training environment in Iran