Research Participants as Workers: Solutions to Medical Exploitation

Abstract: The world of bioethics is riddled with cases featuring the problem of exploitation. Phase 1 research participants are exploited because as they are often formerly incarcerated and cannot find labor elsewhere. Gestational surrogates are exploited when they are used merely as a conduit to reproduce someone else’s child, and treated as such. And, finally, plasma donors are exploited insofar as they are not paid fairly for their plasma ($50 in a $50 billion industry).

In my paper, I argue that the definitions and applications of three prominent formulations of exploitation (vulnerability, instrumentalization, and unfairness) and are each insufficient to fully encapsulate the wrongs and harms we worry about in the ethics of exploitative medicine.
To resolve these insufficiencies, I offer a fourth formulation, drawn from the world of political philosophy of Karl Marx, of exploitation as the extraction of surplus labor. This allows us to more fully explore the rights and justice-based demands of research participants and patients on the medical system.

In so doing, I argue that the exploited are the best knowers and epistemic agents of their own exploitation, and can make demands, often in the form of increased payment and greater access to healthcare benefits, rather than less or banning certain research or behavior, as is often the policy remedy to concerns of exploitation. Similarly, this requires a democratic insight into the need for deliberation and testimony giving amongst those we are most concerned with, rather than proscribing for them top-down policies.