Ethics in health care and research in European transition countries: reality and future prospects.

lower costs on sponsors or researchers, hospitals have strong incentives to take on research projects that may not be in the best interests of the patients or the institution as a whole. Yet it is far from clear that the resources of clinical ethics are particularly apt for addressing these kinds of problems of structural adjustment or professional “deformation.” The language of ethics risks being used to ratify decisions made for reasons of pragmatism or expediency. Institutions may find it more useful to set up ethics committees more to satisfy foreign partners’ or research sponsors’ requirements, rather than to address problems of concern to patients. Ethics committees can serve many useful functions: education, dispute resolution, regulation, policy development. To be genuinely useful to clinicians and patients, and to be morally legitimate, ethics committees need to have both a clear sense of purpose and a clear sense of how best to achieve that purpose. Medical ethics scholars must take up the challenge of addressing the moral problems of social transition, otherwise they will be merely a moral figleaf covering the structural violence in countries in transition.