title: Evolution of European Union legislation on emergency research.
abstract: OBJECTIVE
  Emergency research is necessary to prevent exposure of patients to unvalidated clinical practice (nonmaleficence), and to improve the dismal prognosis of disorders requiring emergent treatment such as cardiac arrest (beneficence). Regulations that govern clinical research should conform to bioethical principles of respect for nonmaleficence, beneficence, autonomy, and justice. Our objectives are to review the evolution of European Union (EU) legislation on emergency research, and to identify potentially remaining problems.
  
  
  METHODS
  EU legislative sources on clinical research and medical literature describing the impact of EU Regulations on emergency research.
  
  
  RESULTS
  Article 5 of EU Directive 2001/20/EC required consent before enrolment in a research study to ensure the autonomy of potentially incapacitated research subjects. However, obtaining such consent is often impossible in emergency situations. Directive 2001/20/EC was criticized for potentially preventing emergency research. Several EU Member States addressed this problem by permitting deferred consent. International ethical guidelines supporting deferred consent were also cited by Good Clinical Practice Directive 2005/28/EC. However, Directive 2001/20/EC was not revised to achieve harmonization of EU emergency research, thus resulting in ongoing "ambiguity" as regards to emergency research legitimacy. This will be definitively addressed by applying EU Regulation No. 536/2014 and repealing Directive 2001/20/EC. The new EU Regulation permits using deferred consent under clearly specified conditions, and may foster emergency research that evaluates interventions posing minimal risk relative to standard practice.
  
  
  CONCLUSIONS
  Legislation related to emergency research in Europe has evolved to increase concordance with bioethical principles so as to increase evidence-based improvements in emergency care.
authors: University of Athens Medical School, Athens, Greece.
authors: Spyros D
authors: SD
authors: Mentzelopoulos
authors: Ecclesiastical Academy of Athens, Greece.
authors: Michail
authors: M
authors: Mantzanas
authors: Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors: Gerald
authors: G
authors: van Belle
authors: Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, USA; University of Washington-Harborview Center for Prehospital Emergency Care, Department of Medicine, University of Washington, Seattle, WA, USA. Electronic address: nichol@uw.edu.
authors: Graham
authors: G
authors: Nichol
mesh_terms: D035843:Biomedical Research / Q000941:ethics / Q000331:legislation & jurisprudence*; D004635:Emergency Medicine / Q000941:ethics / Q000331:legislation & jurisprudence*; D032984:Ethics, Research; D005062:European Union; D006801:Humans; D007258:Informed Consent / Q000941:ethics*
keywords: Emergency medicine; Informed consent; Legislation; Medical ethics; Regulation