To celebrate forty years of publication, we asked people new to bioethics to tell us what should be next on the docket. We received 195 essays. Here are four we especially like.
Bioethics has, until now, focused mainly on those who directly influence human health. It worked to establish guidelines for doctors to follow when treating their patients, and it provided a backbone for ethical human research. Bioethics has done a lot of good, but it is time for the field to branch out to things that affect human health in less obvious ways. Of the things that bioethics must turn its focus to, one of the most pressing issues is establishing a duty of care between pharmaceutical companies and the people they supply.
There has long been a duty of care expected between doctors and patients. Doctors are expected to have the knowledge and skills necessary to perform their job, and they are expected to exercise that knowledge and skill as well as a reasonably competent professional would in the same situation.1 In cases where doctors fail to fulfill this duty, patients are within their rights to sue for malpractice. But it is not only doctors who are held to this standard; nurses, dentists, and therapists can be sued for malpractice as well. What establishes the “duty of care” is the fact that the individual is in some way responsible for the well-being of the patient.
If this is the case, then it also seems that pharmaceutical companies, which provide medicines that are key to human health, could reasonably be thought to have a duty of care to their consumers. This duty of care would be a rather unique thing for a company to have. It is widely held that profit is and should be the most important thing for a corporation to think of. Most companies, though, are not as directly responsible for the well-being of their customers as drug companies are. It is time to work at establishing a mentality that places the good of the populace over the good of stockholders.
Duties of care do more than provide a guideline for behavior. They also provide a firm center of responsibility. Health care professionals are directly responsible for patient well-being, and when they lapse in that responsibility, they are held responsible for the repercussions that ensue. This is something that drug companies desperately need.
Marcia Angell, former editor of the New England Journal of Medicine, once put the basic problem this way: “What does an eight-hundred-pound gorilla do? Anything he wants.”2 The pharmaceutical industry is, without a doubt, an eight-hundred-pound gorilla; drugs are a four-hundred-billion-dollar-a-year industry, and they are unlikely to become less popular anytime soon. This means that guiding pharmaceutical companies’ behavior is extremely difficult, and power, proverbially, has corrupted. Of the three commonly discussed principles of bioethics, pharmaceutical companies routinely violate all three, often while pretending they don’t. This leads to policies that seem clearly to place profit above people.
Let’s start with a discussion of justice. To be entirely fair to pharmaceutical companies, they donate extensively to developing nations and have sometimes slashed prices on drugs so that more people may afford them. Unfortunately, while good definitely comes from donations, there are often also problems with them. First, drug companies receive a significant tax cut for donations. Upon the donation of a drug, the company gains the ability to write off on their taxes the entire cost of manufacturing the drug and 50 percent of its wholesale price.3 This would cause no objections if the companies were complying with the World Health Organization’s guidelines for drug donations. According to the activist organization Réseau Médicaments et Développment, though, companies often donate drugs that are “inappropriate, outdated, or improperly labeled.”4 Additionally, ReMeD adds, the drugs are also often about to expire. Donating these drugs, which would not be marketable [End Page 18] in developed nations, allows the pharmaceutical companies to make a bit of a profit on drugs that would have otherwise been...