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Theorising the 'human subject' in biomedical research: International clinical trials and bioethics discourses in contemporary Sri Lanka

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  • Sariola, Salla
  • Simpson, Bob

Abstract

The global spread of clinical trials activity is accompanied by a parallel growth in research governance and human subject protection. In this paper we analyse how dominant ideas of the 'human subject' in clinical trials are played out in countries that are deemed to be scientifically under-developed. Specifically, we show how rhetorics of individualism, rationality and autonomy implicit in international ethical guidelines governing human subject research are operationalised and localised. We give insights into the ways in which new knowledge forms become embedded in practice. Using the recent upsurge in clinical trials in Sri Lanka as a case study, based on interviews with 23 doctors and researchers carried out during ethnographic fieldwork between 2008-2009, this article explores the tensions that arise for doctors involved with the promotion of bioethics and the attempts to bring local research governance up to international standards. The doctors and researchers intercept, interpret and critique the notions of human subject implicit in new forms of research governance. From their accounts we have identified two concerns. The first is a critique of dominant ideas of the 'human subject' that is informed by ideas of patiency rooted in paternalistic notions of the doctor-patient relationship. Second, 'human subjects' are seen as gendered, and located within family relationships. Both of these bring into question the research subjects' ability to give informed consent and compromise the ideal of an autonomous subject.

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  • Sariola, Salla & Simpson, Bob, 2011. "Theorising the 'human subject' in biomedical research: International clinical trials and bioethics discourses in contemporary Sri Lanka," Social Science & Medicine, Elsevier, vol. 73(4), pages 515-521, August.
    • Handle: RePEc:eee:socmed:v:73:y:2011:i:4:p:515-521
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    3. Wahlberg, Ayo & Rehmann-Sutter, Christoph & Sleeboom-Faulkner, Margaret & Lu, Guangxiu & Döring, Ole & Cong, Yali & Laska-Formejster, Alicja & He, Jing & Chen, Haidan & Gottweis, Herbert & Rose, Nikol, 2013. "From global bioethics to ethical governance of biomedical research collaborations," Social Science & Medicine, Elsevier, vol. 98(C), pages 293-300.
    4. Kamat, Vinay R., 2014. "Fast, cheap, and out of control? Speculations and ethical concerns in the conduct of outsourced clinical trials in India," Social Science & Medicine, Elsevier, vol. 104(C), pages 48-55.
    5. Kate Hampshire & Mwenza Blell & Bob Simpson, 2012. "Navigating New Socio-Demographic Landscapes: Using Anthropological Demography to Understand the ‘Persistence’ of High and Early Fertility Among British Pakistanis [Explorer les nouveaux paysages so," European Journal of Population, Springer;European Association for Population Studies, vol. 28(1), pages 39-63, February.

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