It is time to heed Solomon Benatar's call to disrupt the global research ethics paradigm.

Abstract

The history of research in low- and middle-income countries is rife with practices that have extracted the time, energy, data, biological samples and, in many cases, the health and lives of those who participated, often justified by beliefs about their racial, cultural and civilisational inferiority. As global health research expanded in the late 20th century, this history raised substantial ethical concerns, including exploitation, double standards and the broader social, economic and political contexts in which international research occurs. Although research has contributed to reductions in mortality, morbidity and poverty, its benefits continue to accrue disproportionately to the wealthiest countries, even as access to the fruits of science has been recognised as a human right. In 1999, Prof. Solomon Benatar challenged the Global Forum for Bioethics in Research to confront research as an 'extractive enterprise' and to acknowledge the need for 'a paradigm shift in thinking and action', grounded in interdependence, duties, social justice and the promotion of human flourishing. The prevailing global paradigm, shaped largely by the US Common Rule regulations, emphasises institutional accountability, standardised procedures and a protectionist focus on individual research participants through regulatory compliance. Despite its influence, it remains unclear whether this model has advanced Prof. Benatar's vision of a research enterprise that fosters inclusiveness and promotes the broader societal value of research. We outline possible shifts toward a more proactive, creative, inclusive, context-sensitive and innovative model that embraces empirical testing and global learning, with an emphasis on creating social value. These shifts reflect Prof. Benatar's lifelong commitment to moral imagination, his call to reject extractive practices and his vision of a global research enterprise that enhances human flourishing, especially for the world's most disadvantaged populations.