Abstract

A universal ethical principle is the respect of the individual, and this implies universal rules: informed consent, confidentiality, scientific rigor and the limiting of risks. Applying them involves difficulties which are not limited just to the developing countries and which sometimes pose real problems. To assess the quality of means implemented for making sure that these rules are respected, indicators exist which are either direct (evaluation of good practice, recourse to ethical committees) or indirect (quality of patient management, choice of subjects to be studied). Doubts concerning the application of these rules and the value of these indicators in some developing countries have led to an over-simplification of the issue on the part of those countries which consider themselves as paragons of ethical virtue. This has resulted in the concept of “contextual ethics”. This concept is dangerous because: (1) it creates the impression that any doubts expressed or questions unresolved can only be encountered in poor countries, whereas they underpin all thinking about ethics; (2) it precludes the need for rich countries to call into question the research they perform intra muros without making any reference to the universal right to health care.

Key-words:

Bioethics, Standards, Clinical trial, Aids, Developing countries, Selection of subjects, Stigmatization, Cultural pluralism.