[Research in emergency medicine. Ethical requirements].
Having pointed out some curriculum goals in medical ethics, a plea is made for extensive animal experimentation, especially in emergency medicine in order to minimize necessary investigations in human beings. Although certain groups of patients (persons in custody, minors) are protected nowadays against unjustified research activities by legal restraints, well-designed therapeutic (even nontherapeutic) investigative projects can be facilitated under certain conditions. The same attitude might be adopted for "special" populations (e.g., HIV patients), which are very often excluded for various reasons. Research protocols and statistical evaluation should not be permitted to differ in these groups in comparison to "normal" patients. The issue of "informed consent" in emergency research with the main emphasis on resuscitation cannot be considered as resolved since many patients are unconscious or at least incompetent. Irrespective of the number of legislative constructions proposed mainly in the USA ("proxy consent", "substitute decision making," "deferred consent"--the latter being already declared a misnomer by its "inventor", ethical standards might better be adapted to the respective situations guided by competent ethical committees. As for the particulars of research protocols, randomization combined with a blind or double-blind study design is now considered to be ethically desirable by a majority of authors, the same holding true for risk stratification and sequential test procedures in order to reduce the number of patients required. The "theory of intuitive thinking" is briefly touched upon as a futuristic investigative method and/or decision strategy.(ABSTRACT TRUNCATED AT 250 WORDS)
Steinbereithner
K
K
Ludwig Boltzmann-Institut für Experimentelle Anästhesiologie und Intensivmedizinische Forschung, Wien-Linz.
D004635:Emergency Medicine; D004992:Ethics, Medical; D006801:Humans; D012106:Research
Forschung in der Notfallmedizin. Ethische Voraussetzungen.