title: Ethical challenges in integrating patient-care with clinical research in a resource-limited setting: perspectives from Papua New Guinea.
abstract: BACKGROUND
  In resource-limited settings where healthcare services are limited and poverty is common, it is difficult to ethically conduct clinical research without providing patient-care. Therefore, integration of patient-care with clinical research appears as an attractive way of conducting research while providing patient-care. In this article, we discuss the ethical implications of such approach with perspectives from Papua New Guinea.
  
  
  CONCLUSIONS
  Considering the difficulties of providing basic healthcare services in developing countries, it may be argued that integration of clinical research with patient-care is an effective, rational and ethical way of conducting research. However, blending patient-care with clinical research may increase the risk of subordinating patient-care in favour of scientific gains; therapeutic misconception and inappropriate inducement; and the risk of causing health system failures due to limited capacity in developing countries to sustain the level of healthcare services sponsored by the research. Nevertheless, these ethical and administrative implications can be minimised if patient-care takes precedence over research; the input of local ethics committees and institutions are considered; and funding agencies acknowledge their ethical obligation when sponsoring research in resource-limited settings.
  
  
  CONCLUSIONS
  Although integration of patient-care with clinical research in developing countries appears as an attractive way of conducting research when resources are limited, careful planning and consideration on the ethical implications of such approach must be considered.
authors.affiliation: Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea. drmlaman@yahoo.com
authors.forename: Moses
authors.initials: M
authors.lastname: Laman
authors.forename: William
authors.initials: W
authors.lastname: Pomat
authors.forename: Peter
authors.initials: P
authors.lastname: Siba
authors.forename: Inoni
authors.initials: I
authors.lastname: Betuela
mesh_terms: D035843:Biomedical Research / Q000941:ethics*; D003906:Developing Countries; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D007258:Informed Consent / Q000941:ethics*; D010219:Papua New Guinea; D005791:Patient Care / Q000941:ethics*; D011203:Poverty; D011204:Poverty Areas; D055990:Therapeutic Misconception / Q000941:ethics / Q000523:psychology