Kant’s second consideration would be to base the moral quality of his decision on the intentions of that choice, not the action’s consequences. Thus, the issue cannot be resolved by developing a best case scenario, but must be determined by distinguishing which option is enacted with the best moral intentions. In this way, it is likely that the most morally acceptable choice would be the one which puts Africa’s citizens on an equal consideration with the rest of the world, and so would include providing identical treatment. Thirdly, it is important to make sure that whatever direction is taken, it is taken out of respect for the moral law and for no other reason such as need or desire. To fulfill the third principle, an action cannot violate the categorical imperative. Otherwise, the decision cannot be considered as a moral action.
The moral law, as Kant explained, is a universal formula that ensures all actions are undertaken with pure motives without consideration of the consequences. When deciding whether or not to give Africans the same health benefits that AIDS phase II trial volunteers would receive in other countries, even if they are very expensive, it is important to determine whether the choice could be applied universally. In other words, Kant would compare the options faced by pharmaceutical companies by placing all of them in the categorical imperative, and observe which options are inherent contradictions. When weighing the options using the categorical imperative, the results once again suggests that providing African volunteers with equivalent treatments takes precedence over all other options. The concept of appropriate treatment, if determined only on monetary, social and political status, would seemingly contradict itself if it were considered a universal law. Kant would argue that by issuing care by status, people would be applying a different standard to their own behavior than they would want applied to themselves and everyone else.
The problem with the contradiction argument, critics might argue, is that it may prove difficult if not impossible to provide supporting evidence that universalizing the maxim would result in a contradiction. Advocates would then turn to another method of formulating the categorical imperative to support their position. In the alternate interpretation, known as the second formulation, the categorical imperative serves as a requirement that we must not treat other rational beings as mere means to our own purposes. This tactic allows proponents of equal treatment to establish their position without attempting to prove any inherent contradictions. Instead, they simply have to show that by failing to meet the precedence of care in other countries, pharmaceutical companies are treating people as ends not as means.
Critics may also claim that a truly moral decision would factor in the hard work of the manufacturers of the antiretroviral drugs, as well as anyone else involved in the trials. Kant would not dismiss this assertion. In Metaphysics of Morals, Kant does not attempt to claim that all actions must always be undertaken out of a sense of duty, he simply outlines the necessary components required to establish an individual’s own autonomy based on reason. When considering the dilemma faced by pharmaceutical companies, the only critical consideration is whether the ultimate decision conforms to moral law. They may also argue that the drugs given to Americans and Europeans are so much more expensive to Africans that it cannot be deemed “appropriate” to treat African volunteers with them. To this argument, Kant would refute the idea that the term appropriate should not be applied universally. In his perspective, all humans are rational autonomous agents who deserve the same treatment. If a law or rule cannot be applied universally, a.k.a. fails the categorical imperative, then it should not be considered moral.
The philosophy of the Metaphysics of Morals appears to lend itself nicely to the dilemma of conducting phase II trials in Africa by clearly addressing the major moral concerns involved while at the same time respecting the complexity of the conflict. Kant would recognize that other people’s livelihoods and incomes can be considered when deciding whether or not to provide expensive treatments in Africa, as long as the ultimate decision does not violate moral law. Pharmaceutical companies must insure that they are not manipulating or violating the rational autonomy of their possible test subjects in Africa, but may still consider other variables such as profits and benefits to society. Consequently, pharmaceutical companies appear to have a moral duty to provide adequately equal care to all phase II trial participants in Africa, providing they take steps to insure they are not violating anyone’s rational autonomy in the process.