Under which conditions is international biomedical research in low and middle income countries acceptable? For about 15 years there has been no agreement in the international bioethical community on how to answer this question. Strict positions ask for universal global rules including a global standard of medical care. Others are concerned that this would be too paternalistic and want to leave space for negotiations between the parties involved. We want to point out that each of the positions mentioned above can claim to meet widespread moral intuitions and to be based on widely accepted ethical principles. However, they show also important weaknesses. In order to provide evidence for this, we first outline the general context in which international biomedical research is carried out. After analyzing each position in respect to two problems, the standard of care and reasonable availability, we evaluate two paradigmatic clinical trials from the perspective of both positions. This will help us to demonstrate their weaknesses. Finally, we argue for a middle ground which can correct these weaknesses, and we will as well provide an ethical justification for this middle ground.