Principlism, medical individualism, and health promotion in resource-poor countries: can autonomy-based bioethics promote social justice and population health?
Sociologists have had only a marginal effect on the development of bioethical principles for medical research despite their interest in the effects of social and economic inequality on health and its implications for issues of social and individual justice. In this article we review existing bioethical standards for conducting medical research in very poor countries. Given the substantial differences in individual exposure to health risks and the availability of health protective resources as well as differences in the disease burden and mortality and morbidity at the population level, it is clear that illness in poor countries can be better understood using a social causation of illness perspective. In turn we suggest that such a perspective can be useful for identifying bioethical standards that better apply in this context.