Ethics of children in clinical trials – Kants Imperative
Kant’s imperative can be expressed in a number of ways but essentially he claims that it is always wrong to use another person as an instrument or tool to achieve a purpose that is not of that person’s choosing.
Reasons to agree
This interpretation of Kant’s imperative does seem to echo the concern behind the Declaration of Helsinki that the interests of the person should always be above the interests of science and society. There is an agreement that it would be wrong to use a person, particularly a person in a vulnerable position, as a “thing” or an “object” to achieve benefits for others. It could be argued that the moral concern expressed here is similar to the arguments used to condemn slavery.
Reasons to disagree
There are several points to observe about the argument being made here. The first is that, although the Declaration of Helsinki is an important instrument, it was inspired by a certain point in time and a certain set of particularly horrific circumstances, namely, the medical research atrocities of World War II. It could be argued that the lessons from that time have been learned, and are reflected at many levels, particularly in the laws and regulations governing research, and in the ethical standards used to educate health professionals. We therefore do not need such a rigid statement because the world has learned from the lessons of the past.
A second consideration relies on two points. The first is that it is not obvious that using another person as an instrument is always and everywhere wrong. For example many people recognise the importance of having a capable military force in which soldiers will carry out orders and not follow their own interests at times of national crisis. Moreover it may sometimes be necessary to enforce conscription as a way of maintaining such a force. These points imply that there is at least one situation when it does seem justified to use people instrumentally.
The second requires the deconstruction of the term “interests”. As an individual I have my own interests, the things I need but also the things I value and consider important. Some interests may be personal and some more general. So although I value the good things in my life like my job, my home, the food on my table, these are also opportunities and resources I would like others to enjoy. It is very likely that I could not enjoy these things unless they were in principle available for everyone to enjoy. In society we work together to make such opportunities and resources widely available, and so there is a common good or interest in which we all share. In the context of medicine and healthcare, the interests of science and society are also my interests. It should also be noted that people are often very willing to pursue important societal interests even in circumstances when they are unlikely to benefit personally. So patients do volunteer to take part in clincal trials that they will not benefit directly from in order to contribute to a common good or interest.