Moral Entanglements

Professor of Philosophy, Georgetown University,

Preface ; Chapter 1: Medical Researchers' Ancillary-Care Obligations: ; A Perplexing Issue ; Ancillary-Care Obligations and the Distinctive Ancillary-Care Obligation ; Chapter 2: Special Ancillary-Care Obligations: The Partial-Entrustment Model ; The Existing Lack of Guidance ; Scope: Partial Entrustment of Aspects of Health ; The Variable Strength of Ancillary-Care Claims ; Combining the Tests of Scope and Strength ; Controversy Surrounding the Scope Requirement ; Chapter 3: The Moral Basis of the Partial Entrustment ; A Range of Intimacies ; The Duty to Warn ; Autonomy-Centered Reasons for Privacy Rights ; Ancillary Duties of Care ; Why Those Accepting Privacy Waivers Take on Special Responsibilities ; How the Duty to Warn Blocks Maintaining a Tactful Silence ; How the Duty to Warn Indirectly Supports Tactful Engagement ; How the Duty of Tactful Engagement Provides a Focus for Beneficence ; Returning to the Context of Medical Research ; Potential Rival Accounts: Vulnerability and Threat Avoidance ; Chapter 4: Justice, Exploitation, and Ancillary Care ; Why Special Ancillary-Care Obligations Cannot Rest on Justice ; Will Providing Ancillary Care Conflict with Justice? ; Justice Reinforcing Ancillary-Care Claims ; Chapter 5: Limits on the Waiver of Ancillary-Care Obligations ; The Difficulty of Annulling Ancillary-Care Claims ; Moral Constraints on Soliciting Waivers of Ancillary-Care Claims ; Chapter 6: Gradations of Ancillary-Care Responsibility ; Within the Scope: Minimally, Clearly, or Centrally? ; Variations in the Expectable Depth of the Researcher-Participant Relationship ; Variation in Relative Cost ; Putting These Factors Together ; Conclusion ; Chapter 7: Issues for Further Exploration ; Needed Conceptual Work ; What Does It Mean To Provide Ancillary Care? ; Who Are the Researchers? ; Who Are <"Participants>"? ; What are some of the important boundaries of <"medical research>"? ; What if ancillary non-medical problems are encountered? ; Needed Empirical Work ; Chapter 8: Philosophical Implications and Practical Steps ; Philosophical Implications ; Practical Steps ; References ; Tables ; Table 1: General and Special Grounds of Ancillary-Care Obligations ; Table 2: Functions of Obtaining Informed Consent ; Figures ; Figure 1: The Partial-Entrustment Model's Two Tests ; Figure 2: The Elements Generating Privacy-Based Moral Entanglements ; Figure 3: Privacy-Based Moral Entanglements: Putting the Pieces Together ; Figure 4: Four Grades of Ancillary-Care Obligation for ART Provision ; Cases ; Advanced Cervical Cancer in a HIV-transmission Study ; Brain Scans ; Grimes v. the Kennedy Krieger Institute ; Juba ; Malaria Researchers and Schistosomiasis ; N's Seatmate's Pills ; Quinodyne ; The Massage Therapist and the Mole ; the Nepal Newborn Washing Study ; The Old Man and the Groceries ; The Participant's Feverish Child ; The Reporter and the Peasant ; The Tax Accountant and the Gambling Addict ; Transfusion for a Jehovah's Witness ; Welts