Has emergency medicine research benefited patients? An ethical question.
From an ethical standpoint, the goal of clinical research is to benefit patients. While individual investigations may not yield results that directly improve patients' evaluation or treatment, the corpus of the research should lead in that direction. Without the goal of ultimate benefit to patients, such research fails as a moral enterprise. While this may seem obvious, the need to protect and benefit patients can get lost in the milieu of clinical research. Many advances in emergency medicine have been based upon the results of research studies conducted both within the specialty and by others outside of the field. But has this research benefited patients? Has it followed the Hippocratic commitment "to do good or at least do no harm"? The answer is: yes, and no. This paper attempts to demonstrate this: first by citing advances from applied research that have benefited emergency department patients over the past three decades, and follows with some aspects of emergency medicine research that makes one question both its safety and its efficacy. While enormous gains have been made in patient care as a result of emergency medical research, ethical considerations complicate this rosy picture, and point to future areas of concern for researchers. Some aspects of clinical research and research oversight fall short of meeting the ethical standards of safety and patient benefit. Research agendas are still driven largely by the availability of funds, both from private industry and from government agencies. Many vital patient groups are harmed by omitting or sorely under-representing them as research subjects, most notably those that are critically ill and injured. Finally, questions still arise about clinical researchers' fiduciary responsibility to their subject-patients. Even more important than the institutional safeguards, such as the Institutional Review Boards, is the individual researcher's moral compass, which must serve to protect the subject-patients of clinical research. Overall, emergency medicine research has been and continues to be a moral endeavor. Perhaps the greatest moral lapse has been the lack of attention to key populations within emergency medicine research, and the patients most needing acute intervention are the ones who suffer.
Iserson
Kenneth V
KV
Arizona Bioethics Program, The University of Arizona, 1501 N. Campbell Avenue, P. O. Box 245057, Tucson, AZ 85724, USA. kvi@u.arizona.edu
D026686:Beneficence; D002986:Clinical Trials as Topic / Q000941:ethics; D004635:Emergency Medicine / Q000941:ethics; D032984:Ethics, Research; D006801:Humans; D035842:Research Subjects