the welfare of these populations. This perspective focuses on the idea that justice requires the fair distribution not only of risks but also of benefits.
In this area, the volume Beyond Consent: Seeking Justice in Research has synthesized and extended prior work on justice. In the chapter “Race, Justice, and Research,” King (1998) argues that justice should take us beyond purely distributive concerns to the evaluation and modification of “institutional arrangements” and structures of “decision making and other procedural aspects of research.” Another chapter, “Convenient and Captive Populations,” provides a history of the regulation of research with prisoners, institutionalized persons, military personnel, and students in the United States. It concludes by endorsing a protectionist stance toward these populations, based on histories of abuse, while noting that “there are circumstances in which justice may permit, or even require, access to research” for these populations, such as “the prevalence of a disease that poses a particular threat” to its members and “cannot be studied as effectively with other subjects” (Moreno, 1998).
Similarly, two other philosophers have also thought about the idea that justice requires more than the protection of subjects from exploitation; to be truly ethical, research must actively consider what is best for a population. London, in his work on international research, argues that the permissibility of clinical research should rest in part on its contribution to “filling the gaps between the most important health needs in a community and the capacity of its social structures to meet them” (London, 2005). Even if a particular research project is not, strictly speaking, exploitative, it may still be ethically problematic if it is not the project that has the greatest potential to address the health problems and concerns of the community. Powers (1998) argues that “freedom of choice is important, but the availability of choice-worthy options also is important.” He calls for a complex, comprehensive concept of justice in research that not only synthesizes elements of the various norms (e.g., adopting a dual focus on individuals and groups, benefits and burdens, and upstream and downstream) but also considers the connections between research and other realms of health (or, for that matter, social) policy.
The committee believes that this expanded concept of justice is an important ethical development. Justice requires more than the protection of prisoners from harm caused by the research itself. Ethical research carries with it a responsibility to grapple with the fact that potential harm is ubiquitous in everyday prison life, creating an environment for research in which the choice to participate in a study can be inherently coercive and potentially dangerous. Thus, in order for research to be ethical, justice requires that it must be done in a setting in which there is an adequate standard of health care in place.
How to assess the adequacy of a correctional health-care system? The committee acknowledges that the vast majority of researchers and IRBs do