The dominant bioethical paradigm that provides the context for research ethics discourse has evolved within Western philosophy’s powerful normative framework and is built on a relationship model that explains and underpins the obligations doctors have to their patients. In this one-to-one relationship, the doctor is claimed to have primary duties to do no harm to patients and to respect patients’ rights. Employing the values of liberal individualism currently dominant in Western civilization, this model provides the starting point for understanding ethical research practice. Hence, researchers, like doctors, have obligations to do no harm to subjects and to respect their rights within the dominant conception of what these rights are or should be.

Spectacular progress, both intellectual and material, has been achieved through the Enlightenment notion of the centrality of the individual and the supremacy of science and technology in advancing health and healthcare practices. The modern Western belief system and its frames for global thinking that have now become powerful worldwide are succinctly characterized by an individualistic, self-determining, and rights-bearing concept of being; an epistemological framework that centers on abstract thinking, objectivity in observation, logical reasoning processes, verifiable knowledge, and a positivist version of the scientific method; and moral and political values of autonomy supportive of individual rights. Scientific and technological progress and diverse socioeconomic systems contributed to fostering great “accelerations” in the scale of production, consumption, communication, and transportation that in particular since 1945 have improved the duration and quality of life for many people.

Improving and promoting global health continues to be one of the largest and most important challenges facing humanity in the twenty-first century. The task has become even more difficult since our first edition appeared almost a decade ago, given the accelerated destruction of the planet and the associated compounded threats to health that now present themselves. The emergence and spread of COVID-19 and the implications of this pandemic for life, health, and our planet exemplify how the world can change so rapidly and profoundly. The domino effects of the pandemic in an unstable global system are triggering multiple tipping points with implied radical alterations to the trajectory of life as we have known it. This is a stark reminder that despite all the major advances in science, healthcare, health, and longevity since the Enlightenment, and despite all the promises of genetic medicine and artificial intelligence, the long-term health and survival of our species are now, more than ever, intensely threatened.

Summary

Global health is arguably the most pressing moral challenge for human security and well-being in the twenty-first century. In seeking solutions to this, I begin by suggesting the need to acknowledge that the world is in a state of entropy. This is reflected in widening disparities in health across the planet (despite major advances in science and medicine and spectacular economic growth), the emergence and spread of many new infectious diseases, climate change and the recently evolving global economic crisis – all of which are already having devastating effects on population health. These trends will continue if we fail to take appropriate action, and they reveal the need for new paradigms of thinking and action that require a shift in the spectrum of our value system from one dominated by a highly individualistic, competitive, scientific, market approach to health and well-being to an orientation that, while retaining the best of these values, is more inclusive of solidarity, cooperation and socio-economic and ecological sustainability considerations. A thrust towards making such progress could be promoted by expanding the discourses on ethics and human rights, and by developing the global state of mind essential for progress in an increasingly interdependent world.

Introduction

It is becoming apparent to some scholars that global health is the most pressing moral challenge for human security and social well-being in the twenty-first century (Benatar 2005). If this is an accurate diagnosis (and I do not intend to provide the evidence or rationale for this here, as there is already a voluminous literature on this topic), then the next step towards seeking solutions is to achieve widespread acceptance of this diagnosis. Only then can we begin to consider and take appropriate action.