Sometimes, when faced with difficult choices, those concerned may decide that the most ethical route would be not to proceed with the study at all. But if the outcome of the study would , for example, be a vaccine which would save the lives of a great number of children, then the decision has to be carefully balanced. Is it ethical to block research that would assist many just because it does not meet the ‘gold standard’ of ethics?

"You get stuck sometimes and you need to find a balance. In the end you have to see where to compromise," was the view of one delegate from a developing country.

The Global Forum, unlike other bioethics gatherings, did not begin at the point of lofty philosophical principles but rather with the practical everyday problems that scientists faced, and from this starting block it beat a path through to an ethical principle. Along the way, there were many twists and turns with groups considering the case studies sometimes coming up with completely divergent views on what would be the ethical route to take at each juncture of complicated cases - for example, what would happen to people who had been harmed through participating in a drugs trial? How would researchers arrive at a decision that one group of children would not be vaccinated for the purposes of their study?

A recurring theme was the gap that exists between ethical guidelines and actual health research practice. In clinical trials, for example, the risks and possible benefits, both during and after the trial, are not always disclosed.

There are a myriad of guidelines, but many participants were concerned that they are all set within a framework of predominantly Western thinking, which means that their potential to guide research in developing countries is limited. The question was raised as to why having a few developing country representatives on the committees which have traditionally prepared the guidelines was not enough. The answer that came from developing country participants was that it was difficult to influence the thinking of such committees in a fundamental way and there was a need for engagement of developed and developing country representatives on equal terms. Only an entirely new approach could move the process from the centre, but that depended on shaping national guidance frameworks in developing countries.

Another question asked throughout the forum was do existing guidelines work and do countries have the capacity to follow them?

OPAS Brazil