CYIL vol. 11 (2020)

MARTIN ŠOLC CYIL 11 (2020) need to be pursued always and under all circumstances. The exceptions are possible when research does not have to – and arguably must not – be carried out. When thinking about the limits of research, we first need to assess the conformity of the relevant maxim with another formula of categorical imperative – the formula of humanity 93 . This formulation is as follows: “So act that you use humanity, whether in your own person or in the person of any other, always at the same time as an end, never merely as a means.”  94 Arguably in any activity, we treat others as a means to some end – but we have to always treat them also as ends in themselves, respecting their inner value and dignity. That is no less true for medical research. If a child is subjected to a research study, she or he is being used as a means to expand scientific knowledge, but at the same, she or he needs to be respected as a human person that is an end in herself or himself. It has not been consensually established what it means to use research participants as ends in themselves 95 . On a general level, though, there is arguably no safer way to secure this than making sure that research always respects the minor’s best interests. We will now try to assess whether the above-described principles of research on minors that are intended to protect the best interests of the child participating in research are really in line with the outlined Kant’s formulas of categorical imperative. 3.1.1 Assessment of the three principles of research on minors The principle of autonomy is undoubtedly an important expression of respect to the person and her or his dignity. The corresponding maxim could be formulated as “interfere with the integrity of another only if she or he assents to it, given she or he has the capacity to make such a decision”. It could be even added that “you shall never interfere with the integrity of another person if she seriously objects”. However, we need to bear in mind that one is obliged to use humanity as an end not only in others but also in herself or himself (after all, it is a perfect duty not to commit suicide). A person simply cannot agree to be used merely as a means. Therefore, under Kantianism, the autonomous choice cannot be a sufficient condition for the justification of participation in medical research (or of anything, for that matter). The principle of subsidiarity can be expressed as a simple maxim: “involve minors in research only if the results of this research cannot be obtained otherwise”. It has surely been adopted and developed with the deontological purpose of the protection of children. If minors were merely used as a means to expanding scientific knowledge, there would probably be no need to exclude them from research as long as their participation would have advantages for the researchers and society (for example, the costs would be lower, the results would be obtained faster, etc.). A more generalised maxim based on the principle of subsidiarity could be: “never put minors at risk if it is not necessary for achieving the intended result”. In this wide formulation, it certainly does not contradict categorical imperative. At the same time, it does not suffice for the justification of research. It is not possible to justify research on minors by noting that under different conditions, the research would not take place. There 93 See ibid., p. xxi. 94 KANT, Immanuel. Groundwork of the Metaphysics of Morals. Cambridge University Press, Cambridge 1997, p. 38. 95 See VAN DER GRAAF, Rieke, VAN DELDEN, Johannes J. M. A Paradigm Change in Research Ethics. In SCHILDMANN, Jan, SANDOW, Verena, RAUPRICH, Oliver, VOLLMANN, Jochen (eds.). Human Medical Research. Ethical, Legal and Socio-Cultural Aspects. Springer, 2012, p. 157.

422