In an increasingly interdependent world we are all threatened by widening disparities in wealth and health, and by failure to achieve the goal of more widespread respect for basic human rights. In such a world, further complicated by significantly different cultural perspectives on the good life, it is necessary to consider how relationships between individuals, institutions, and nations should be structured in order to reduce injustice and improve prospects of human well-being, peace, and security.
In Ch. 43, Solly Benatar outlines global disparities, defines global bioethics, argues that global bioethics is important, and examines how cross-cultural differences could be considered and reconciled in theory and in medical practice without resorting to moral relativism.
In Ch. 44, Jerome Singh examines the legal and ethical responsibilities of health professionals in relation to care of those who are victims of torture and degrading treatment. After defining dual loyalty and describing how dual loyalty dilemmas arise, he refracts the rights of detainees through the “lens” of the principles of biomedical ethics, and shows how international human rights law, several United Nations Resolutions and international medical ethics guidelines provide a framework for protecting such vulnerable persons. His chapter, inclusive of a description of how it is possible for those in authority to become complicit in abusing detainees, is of special topical interest given the recent treatment of detainees in Guantanamo Bay and Abu Ghraib prisons.
The HIV/AIDS era has focused world attention on lack of access to essential life-extending drugs for millions of people. Moving from concerns about individuals to concerns for whole groups of people, Jillian Clare Cohen and Patricia Illingworth address in Ch. 45 the question of how access to medicines for all could be improved. They attribute the imbalance in access at a global level to government and market failures and then describe how changes to Trade-Related Aspects of Intellectual Property (TRIPS) coupled to enhanced corporate social responsibility could facilitate improved access to necessary drugs globally.
Moving to what ought to be done to narrow injustice at a global level, Gopal Sreenivasan concludes the section by arguing in Ch. 46 that, in the absence of a theory of international distributive justice to which all could agree, it would be possible to reduce disparities in wealth and health significantly through the application of ideas emanating from a theory of non-ideal justice.
A clinician might ask, “Why should clinicians care about global health ethics? I am already faced with a multitude of local ethical dilemmas and issues, why should I think global bioethics affects my clinical practice?” Firstly, because this book is aimed at clinicians in both industrialized and developing nations, it illustrates that, to varying degrees, there are problems in many healthcare settings with access to and distribution of medical services and in respecting human rights. Secondly, clinicians practicing in the industrialized world should have some sense of solidarity with their colleagues in the developing world, especially regarding some of the more pressing issues they face. Thirdly, it highlights to clinicians the importance of recognizing the existence of reasonable ethical pluralism in bioethics and how different cultural and political conditions affect our conception of bioethics in industrialized nations.
The chapters in this section do not attempt to deal comprehensively with all aspects of global bioethics and global health ethics. However, we hope that they provide readers both with a sensitizing introduction to a broad set of ethical considerations on issues that impact profoundly on the health of whole populations and with references through which to pursue further study.