A failure in solidarity: Ethical challenges in the development and implementation of new tuberculosis technologies

Abstract

Prominent tuberculosis ( TB ) actors are invoking solidarity to motivate and justify collective action to address TB , including through intensified development and implementation (D&I) of technologies such as drugs and diagnostics. We characterize the ethical challenges associated with D&I of new TB technologies by drawing on stakeholder perspectives from 23 key informant interviews and we articulate the ethical implications of solidarity for TB technology D&I. The fundamental ethical issue facing TB technological D&I is a failure within and beyond the TB community to stand in solidarity with persons with TB in addressing the complex sociopolitical contexts of technological D&I. The failure in solidarity relates to two further ethical challenges raised by respondents: skewed power dynamics that hinder D&I and uncertainties around weighing risks and benefits associated with new technologies. Respondents identified advocacy and participatory research practices as necessary to address such challenges and to motivate sustained collective action to accelerate toward TB elimination. We present the first empirical examination of bioethical accounts of solidarity in public and global health. Our study suggests that solidarity allows us better to understand and address the ethical challenges that arrest the D&I of new TB technologies. Solidarity lends credence to policies and practices that address the relational nature of illness and health through collective action.

Data Sharing During Pandemics: Reciprocity, Solidarity, and Limits to Obligations

“…Acknowledging that the concept of solidarity is contested and may admit of different interpretations in different areas of practice and scholarship, for the purposes of this paper we take solidarity to denote persons in positions of power centring the values and experiences of marginalized persons, while standing with them to promote just practices and policies. Solidarity can be understood relationally and “ … holds that individuals and communities are bound together, or mutually interdependent, and thus, that personal and collective well‐being are intimately linked” (Komparic, et al 2019 , 559). It can be understood as an intrinsic value that is foundationally good in-and-of-itself (Jennings and Dawson 2015 ) or as instrumentally valuable insofar as it promotes other values or norms (Prainsack and Buyx 2017 ), e.g., sharing vaccines means lowering everyone’s chances of catching nastier, mutated strains of a particular virus.…”

Defining ethical challenge(s) in healthcare research: a rapid review

“…Of the 53 empirical studies, 42 (79%) were qualitative studies [ 34 – 36 , 38 – 44 , 47 , 48 , 50 – 52 , 54 – 58 , 60 , 62 – 67 , 69 , 71 – 77 , 79 – 81 , 83 – 86 ], 6 (12%) used a mixed methods approach [ 45 , 46 , 53 , 59 , 61 , 68 ], and 5 (10%) were quantitative [ 37 , 49 , 70 , 78 , 82 ]. 7/56 empirical studies, all qualitative interview studies, recruited participants internationally with no specific location stated [ 40 , 54 , 55 , 58 , 60 , 63 , 73 ]. Of the remaining studies, all but one were single-country studies: Botswana [ 75 ], Canada [ 41 , 65 ], China [ 57 ], Denmark [ 39 , 43 ], Dominican Republic [ 44 ], Germany [ 51 , 84 ], India [ 61 ], Iran [ 38 , 46 , 49 , 68 , 70 – 72 , 78 , 82 , 98 ], Italy [ 45 ], Mexico [ 87 ], the Netherlands [ 76 ], New Zealand [ 47 ], Norway [ 42 , 52 , …”

Solidarity during the COVID-19 pandemic: evidence from a nine-country interview study in Europe

“…This article highlights the value of understanding solidarity through a prism of a practicebased approach that allows us to identify multiple and varied forms of solidarity at different stages of the pandemic, hence circumventing some of the operational problems that might otherwise arise from discussing an often poorly defined concept. We do this by adopting the definition of solidarity by Prainsack and Buyx (2017) that encompasses practice-based understandings, which has proved to be a fruitful lens for researching enactments of solidarity in healthcare (Komparic et al 2019). Prainsack and Buyx (2017, 52) argue that the recognition of similarity with another person that in turn gives rise to a solidaristic action is a key element in explaining solidaristic practices: 'Solidarity is an enacted commitment to carry "costs" (financial, emotional or otherwise) to assist others with whom a person or persons recognise similarity in a relevant respect'.…”