Intro
The ethical justification for developing and providing the means to reduce the burden of disease in developing countries is self-evident. Nevertheless, those who pursue these laudable ends encounter ethical dilemmas at every turn. The development of new interventions requires testing with human subjects, an activity fraught with controversy since the dawn of scientific medicine and especially problematic with poor and vulnerable participants in developing countries. Ethical dilemmas arising in setting priorities among interventions and among individuals in need of care are most acute when needs are great and resources few.
We address some of these concerns in this chapter, identifying some of the principal ethical issues that arise in the development and allocation of effective interventions for developing countries and discussing some alternative resolutions. We omit discussion of two other aspects of these ethical decisions: ensuring that the process of decision making is fair and involves the subject population (Daniels 2000; Holm 1998), and respecting legal obligations under international human rights treaties (Gruskin and Tarantola 2001).
