restricted access 19 Global Health Inequalities and Bioethics
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c h a p t e r n i n e t e e n Global Health Inequalities and Bioethics l e i g h t u r n e r , p h.d. What moral issues belong at the heart of bioethics rather than on the periphery of the field? Although priority setting and resource allocation in medicine and health care are important topics for bioethicists, few publications in bioethics explicitly address what priorities ethicists should have when crafting research agendas , teaching, publishing, and engaging in public debate. Amid a sea of possibilities , which topics should bioethicists address and strive to bring to the attention of journalists, policy makers, health care providers, citizens, and politicians? Furthermore , just who is entitled to make such judgments about the relative merits of particular domains of research? Should funding agencies seek to influence research programs in bioethics? Should directors of bioethics centers play leading roles in establishing pathways for more junior scholars to follow? Does the concept of academic freedom mean that bioethicists are entitled to cultivate whichever academic gardens they choose to till? How much scholarship in bioethics is driven by careerism and the reward structures of academe rather than larger moral and social concerns? Sociologists interested in the emergence of bioethics ask just such questions about the intellectual substance and disciplinary boundaries of bioethics (Bosk 1999; De Vries 2004). However, such matters are not simply for scholars interested in the sociology of bioethics. Bioethicists need to critically assess what they do, why they pursue particular agendas, and whether they might make better use of their capacities as researchers and educators. limits to bioethics I became interested in questions concerning research agendas in bioethics as a result of my gradual realization that, although bioethics addresses important topics, it also neglects the study of many urgent moral issues related to health and illness. For example, bioethics directs considerable attention to risks associated with gene transfer technology but pays little attention to how homelessness and poverty affect mortality, morbidity, and everyday life, even though social welfare programs have normative dimensions. Similarly, while many bioethicists attend to ethical issues raised by the creation of genetically modified organisms, they neglect ethical dimensions of marketing and distributing fast food and cigarettes to low-income populations. Increasing numbers of bioethicists address ethical issues related to biotechnology, nanotechnology, and neuroethics. Though global health ethics is emerging as an area of scholarship within bioethics, even this subject is attracting scholars interested in exploring how nanotechnology, genomics, and the life sciences are going to transform the developing world. Anyone with even a rudimentary understanding of population health in developing societies would be astonished at this choice of focus for global health ethics. The shape of bioethics could be much different from its current form. There is much to be said in favor of encouraging bioethicists to critically assess what they do, what they study, and whether they ought to conform to the field’s existing reward structure. Bioethics needs to become much more engaged in addressing global health inequalities. “Global health” is the term sometimes used to draw attention away from the study of particular individuals or populations and toward a more cosmopolitan , transnational mode of analysis. A full discussion of this topic would require a detailed exploration of globalization processes, the development of an international network of human rights organizations, and the establishment of such transnational institutions as the World Health Organization and the World Medical Association. Here, I do little more than sketch what deserves to be a major area of study in bioethics. global health inequalities Most bioethics scholarship emerges within wealthy, technologically advanced societies. Bioethics research within these countries predominantly addresses ethical issues situated within resource-rich social orders. In describing such countries as Australia, Canada, Great Britain, and the United States as “developed” and 230 d e f i n i n g v a l u e s a n d o b l i g a t i o n s “wealthy,” I recognize the existence of major health disparities within these nations (Isaacs and Schroeder 2004). Acknowledging the importance of addressing health inequalities within wealthy countries, I want to draw attention to the profound inequalities in the health of populations and access to health care around the world. The burden of disease is differentially distributed across populations (Michaud , Murray, and Bloom 2001). Some populations have managed to largely escape from long-standing causes of morbidity and mortality. In these countries, chronic diseases rather...