US military medical ethics evolved during its involvement in two recent wars, Gulf War I and the War on Terror. Norms of conduct for military clinicians with regard to the treatment of prisoners of war and the administration of non-therapeutic bioactive agents to soldiers were set aside because of the sense of being in a ‘new kind of war’. Concurrently, the use of radioactive metal in weaponry and the ability to measure the health consequences of trade embargos on vulnerable civilians occasioned new concerns about the health effects of war on soldiers, their offspring, and civilians living on battlefields. Civilian medical societies and medical ethicists fitfully engaged the evolving nature of the medical ethics issues and policy changes during these wars. Medical codes of professionalism have not been substantively updated and procedures for accountability for new kinds of abuses of medical ethics are not established. Looking to the future, medicine and medical ethics have not articul
[Historically] the public has remained suspicious of much experimental research which, as a result, was often done on prisoners, orphans, the mentally challenged, and other captive populations without informed consent. But with the emergence of AIDS in the early 1980s, everything changed. Highly organised groups of gay men, confronted with a mysterious life-threatening disease, aggressively advocated for greater research funding and for early inclusion in experimental trials. Their arguments were persuasive enough for the US Food and Drug Administration to revise its protocols, expediting the drug approval process. [A number of moral concerns are raised by this shift in policy] and although groups such as Abigail's Alliance have urged US courts to find a constitutional right for terminally ill patients to get access to unapproved experimental therapies, recent rulings have gone in the other direction.
Poor people predominate as a subgroup of those who take part in healthy volunteer research. They are subjected to minimised but unknown risks and unpleasant burdens so that the safety of new medicines can be evaluated. This is prima facie unfair especially given that the poor are often unable to access expensive medicines. Although participants in this kind of research often do receive compensation for their time, these payments are usually capped at a very low level. This paper defends a version of a reimbursement model for the payment of research subjects. This model is practical, would benefit those without an income who take part in research, and would make it possible for those in regular work to take part in phase 1 research.