Ethics is not just for ethicists

EDITOR—Singer and Benatar's editorial on revisions of the Declaration of Helsinki proposes “capacity development,” defined as an increased number of professionals trained in ethics.1 Although this is indeed a step that needs to be taken, I cannot agree that it alone will advance the cause of ethical research, especially with the plans that the authors propose.

The assumption that having more trained people will change the system satisfies a necessary but not sufficient criterion. The fact that there are more doctors in the developing world today than there were 20 years ago does not mean either that the practice of medicine is better or that health needs are addressed. It depends on what these people trained in ethics do, where they do it, how they sustain their efforts, and how they integrate their contributions within the overall health development of nations.

The numbers and budgets presented in the proposal are simply arbitrary—they are not defended and so are difficult to evaluate. If $100m is available, what are the alternative pathways for investment for the developing world? If one considers all the health and staffing needs then the need for ethics training may not be the most important: community health workers, trained birth attendants, and others may be higher on the list. Another major issue is where the money goes. Implicit in the editorial is that the money will have to go to training centres in the West. This …