Political Structures & Ethics

On Tuesday we were lucky enough to have Bob Brecher from the University of Brighton giving a talk as part of our Science and Society public lecture series here at the University of Ulster. He talked primarily about about moral responsibility focusing on whether scientists were responsible for the use of their creations. His overall conclusion was that they had no special responsibilities, any more than others do in their performance of being citizens, and their performance of duties associated to their role. A key point he made is that ethical responsibility is mediated in part by political structures.

This struck me as an important point, namely that you can only be held responsible in so far as there are meaningfully viable alternatives available. In a sense then this makes political theory prior to ethics, in that without a fair political system, people will often be put in a position, through no or minimal fault of their own, where every option is bad. What Bob then went on to argue is however that we all share responsibility for the social and political structures around us, and that we ought to endeavour to change these.

Its this sort of big picture thinking that is sorely needed in bioethics which has I think for too long focused on what should be done in specific cases and thrown its collective hands up on solving overarching political and social problems, which actually create these cases in the first place. This is what I think is so striking for example about Thomas Pogge's work, is that Pogge clearly understands that if we want to bring about circumstances where people can ethically flourish we need to change the political structures, rather than just complain about their behaviour. This is best illustrated by Pogge's work on changing the incentive structures that surround pharmaceutical corporations.
The need for this in regards to distributive justice and health care are obvious, but I wonder if there are other areas where this sort of big picture thinking might be useful? One that springs to mind immediately in the UK is that currently the NHS refuses to provide non-negligent harm indemnity to those involved in clinical trials. Which means even if you are significantly harmed by being involved in a clinical trial, there is no structure to provide support for you (other than medical care), unless the harm happens as a result of researcher negligence rather than as a side effect of being involved in a first in human trial. Individual Research Ethics Committees (RECs) can do little about this even if their members all agree that this is poor practise, since if they reject all of these sorts of studies that come in front of them it will make little difference overall. However if RECs banded together and agreed to reject these studies I suspect the NHS position would change on this quite fast...

Any other areas you can think of, where this may happen?