The ethics of clinical research

Abstract

Improvements in the care of individual patients have been recently stated to be the main result of advances in two distinct fields of modern medicine; biomedical research and clinical ethics [Forrow, Wartman and Brock, 1988]. Biomedical science and ethics are not only both essential in the day to day clinical care of patients but should together also underlie all aspects of clinical research. There is an increasing awareness by the medical profession and the general public of the growing complexity of medical ethics. Technological advances in medicine, at times accused of dehumanizing the doctor-patient relationship, are raising new ethical issues, problems that did not exist a few decades ago. Such issues as organ transplantation, the legal and ethical considerations of in vitro fertilization, artificial insemination and donor embryo transfer have all hit the newspaper headlines. There are other problems perhaps not so much in the limelight, but non~theless worthy of equal consideration, such as the ethical issues involved in the long-term care of the aged and the legal and ethical aspects of drug therapy and pharmaceutical promotion. I have chosen to discuss briefly the ethics of clinical research because it is a field in which I have most direct experience, having been involved in this discipline for the past twenty years and also because it lies at the basis of many of the issues I have just listed.