(Mis)Understanding Exploitation (Feature Article) (Report‪)‬

The notion of exploitation frequently crops up in -A- discussions about the ethics of biomedical research. A standard concern about clinical trials is that they exploit research subjects for the benefit of future patients. This concern is particularly emphasized when participants in clinical trials are drawn from vulnerable social groups and when research takes place in developing countries. (1) Some suggest that a major rationale behind ethical principles and guidelines governing research with humans is to avoid exploitation. (2) Yet it is unclear what exploitation means in the research context. The lack of clarity is hardly surprising, since exploitation is not as well-established a part of the bioethics toolbox as other concepts, like autonomy and harm. Exploitation has also received comparatively little philosophical attention outside of bioethics, and philosophers who have analyzed it disagree considerably about what exploitation is, when it is wrong, and why. (3) Although some authors in research ethics have questioned the usefulness of exploitation discourse, (4) recent works have shed new light on the meaning of exploitation in clinical research, and several common misconceptions have been identified and dispelled. (5) However, more conceptual clarification is needed. This paper is not an attempt to develop a full account of exploitation in research, nor will I try to systematically apply any more general theory to this particular case. I will instead challenge one influential way of talking about exploitation in the research context: the so-called nonexploitation framework that a group of leading research ethicists have proposed in several recent papers. (6) I contend that one core element of the framework--the idea that nonexploitation in research requires that participants are not exposed to excessive risk--while seemingly sound, is in fact quite mistaken and misleading. A reflection on exploitation in other practices reveals why this is so.