Nevertheless, the payment continues to raise numerous conceptual, ethical and practical controversies among bioethicists, investigators, research ethics committees/institutional review boards (RECs/IRBs), and other members of the research community. Paying research subjects for their participation in biomedical studies is an increasingly common practice across different types of research involving healthy volunteers and patients (Grady et al. Without full understanding of the ethical anatomy of payment, it is impossible to determine what we owe, if anything, to research subjects-what for, and how much research participants should be paid. It presumes that any discussion on ethically sound payment practice should be preceded by a clear statement of ethical reasons for paying research participants, their deontic nature and mutual relations. This paper aims at clarifying these issues. Equally, there is no common view on what constitutes an ethical source of this purported obligation or acceptability of payment (as such or of a certain kind), and which ethical reasons lie behind different payment categories and schemes. As a consequence-while there is a growing consensus that an ethically sound payment scheme should avoid both excessive payment and underpayment, and it should include, at least, reimbursement of reasonable expenses and compensation for some contributions made by research subjects-there is no generally accepted view on whether a payment to research subjects (as such or of a certain kind) is a moral obligation (Council for International Organizations of Medical Sciences 2016), merely an “acceptable practice” (Food and Drug Administration 2018), “ethically discretionary” activity (Persad et al. Instead of exploring the ethical foundations of payments systematically, scholars and public-policy makers rather focus on payment-related ethical concerns, in particular of undue inducement and exploitation, and-from this perspective-recommend or discourage certain forms, schedules and timings of payment commonly used in research practice (e.g., Macklin 1981 Dickert and Grady 1999 Grady 2001, 2005 Gelinas et al. What are the ethical principles or values which constitute an ethical rationale for paying research subjects? Do those create a moral obligation to pay individuals for participation in biomedical research, or rather a mere justification for its acceptability? What other ethical principles and values shape the payment practice, and how? Surprisingly, these questions have been rarely the subject of in-depth discussions in the literature. The principle of justice provides a strong ethical reason for not offering recompenses for lost wages (or loss of other reasonably expected profits). Other ethical principles of research ethics (respect for autonomy, individual beneficence, and justice/fairness) make up an ethical “skeleton” of morally sound payment schemes by providing additional moral reasons for offering participants (1) recompense for reasonable expenses and (2a) remuneration conceptualized as a reward for their valuable contribution, provided (i) it meets standards of equality, adequacy and non-exploitation, and (ii) it is not overly attractive (i.e., it does not constitute undue inducement for participation or retention, and does not encourage deceptive behaviors) or (2b) remuneration conceptualized as a market-driven price, provided (i) it is necessary and designed to help the study achieve its social and scientific goals, (ii) it does not reinforce wider social injustices and inequalities (iii) it meets the requirement of non-exploitation and (iv) it is not overly attractive. This principle constitutes an ethical “spine” of the practice. It argues that researchers have a prima facie moral obligation to offer payment to research subjects, which stems from the principle of social beneficence. In contrast to most publications on the ethics of paying research subjects, which start by identifying and analyzing major ethical concerns raised by the practice (in particular, risks of undue inducement and exploitation) and end with a set of-more or less well-justified-ethical recommendations for using payment schemes immune to these problems, this paper offers a systematic, principle-based ethical analysis of the practice.
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