Shusaku Endo may be the greatest Japanese novelist who didn’t win the Nobel Prize. He is best known in the West for his novel Silence, about Christianity in 17th Century Japan, which was recently made into a film by Martin Scorsese. But one of his early novels touches upon the ethics of clinical research. Based upon a historical incident which took place just weeks before the end of World War II, The Sea and Poison relates the moral corruption of doctors who vivisected several American prisoners of war.

It’s hard to get, but well worth reading, as it exemplifies the hazards of research on prisoners. Almost no population is more vulnerable to exploitation by clinical researchers than prisoners. Even if they benefit from the research in some tangential way, a more powerful motivation may be their desire to please prison authorities.

Many bioethicists have written about this difficult ethical issue, but this doesn’t make it any easier to make a decision in practice. Below is an article about proposed clinical trial conducted in prisons to determine whether low-salt diets are healthier. What do you think?

Michael Cook
The difficult ethics of clinical research
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prison ethics