tions on "parallel track" include the formation of a national human subjects review panel for that system and would be a good, although limited, first step.

A broadly based, thoughtful, and experienced group could provide direction and leadership when both are greatly needed. The resolutions to the questions raised by HIV/AIDS research will affect research in many other contexts. While the basic principles of research ethics have proven their value in the context of HIV/AIDS, their implementation has already been profoundly altered.

Looking to the future, some issues will clearly be on the agenda. As the number of women infected with HIV increases, there will be more pressure to include them in drug trials. Yet, as already noted, there is no consensus about the inclusion of women of childbearing age, much less pregnant women, in drug trials. The encouraging news on vaccine development from the Sixth International Conference on AIDS in San Francisco in June 1990 makes it more likely that large-scale efficacy trials will be proposed, raising to more than hypothetical status the ethical issues inherent in their design and implementation. Widespread access to investigational drugs is a major social experiment; beyond data collection on individual drugs, the process should be evaluated, especially in terms of its impact on clinical trials and on patients' well-being and autonomy.

In the coming years, debates about research ethics will focus more broadly on the economic, social, and political links between the research enterprise, the rest of the health care system, and society in general. The challenge is to uphold ethical research standards in the current health care system while at the same time trying to redress its inequities.


ACKNOWLEDGMENTS

Work on this chapter was supported in part by a grant from the American Foundation for AIDS Research. Some of the material in this article appeared in different form in my articles, "Has AIDS Changed the Ethics of Human Subjects Research?" Law, Medicine and Health Care (Winter 1988) and "Women and HIV/AIDS Research: The Barriers to Equity", Evaluation Review ( October 1990). I would like to thank two groups for their contributions to my appreciation of the many values at stake in HIV/AIDS Research: the participants of the American Foundation for AIDS Research Clinical Ethics Consensus Working Group (particularly my coprincipal investigators, Nancy Dubler and Robert J.

-101-

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AIDS & Ethics
Table of contents

Table of contents

  • Title Page iii
  • Contents vii
  • Preface ix
  • Contributors xv
  • 1. Aids: the Relevance of Ethics 1
  • Note 22
  • References 23
  • 2. Aids, Public Health, and Civil Liberties: Consensus and Conflict in Policy 26
  • References 47
  • 3. Mandatory HIV Screening and Testing 50
  • References 73
  • 4. Aids and the Ethics of Human Subjects Research 77
  • Acknowledgments 101
  • References 102
  • 5. Aids and the Crisis of Health Insurance 105
  • References 124
  • 6. Ethical Issues in Aids Education 128
  • Acknowledgments 151
  • Notes 151
  • References 153
  • 7. Ethics and Militant Aids Activism 155
  • Notes 186
  • References 186
  • 8. Aids and the Physician-Patient Relationship 188
  • Notes 211
  • References 213
  • 9. Aids and the Obligations of Health Care Professionals 215
  • References 236
  • 10. Aids and Privacy 240
  • Acknowledgments 272
  • Notes 272
  • References 274
  • 11. Aids and the Law 277
  • References 305
  • SUGGESTED READINGS 306
  • Index 311
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