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rely on many other physicians, often in different countries, to enroll
patients as research subjects.
Although such participation in research is valuable experience for
physicians, there are potential problems that must be recognized and
avoided. In the first place, the physician’s role in the physician-patient
relationship is different from the researcher’s role in the researcher-
research subject relationship, even if the physician and the researcher
are the same person. The physician’s primary responsibility is the
health and well-being of the patient, whereas the researcher’s primary
responsibility is the generation of knowledge, which may or may not
contribute to the research subject’s health and well-being. Thus, there
is a potential for conflict between the two roles. When this occurs, the
physician role must take precedence over the researcher.
Another potential problem in combining these two roles is con-
flict of interest. Medical research is a well-funded enterprise, and phy-
sicians are sometimes offered considerable rewards for participating.
These can include cash payments for enrolling research subjects,
equipment such as computers to transmit the research data, invitations
to conferences to discuss the research findings, and co-authorship of
publications on the results of the research. The physician’s interest in
obtaining these benefits can sometimes conflict with the duty to pro-
vide the patient with the best available treatment. It can also conflict
with the right of the patient to receive all the necessary information to
make a fully informed decision whether or not to participate in a re-
search study.
These potential problems can be overcome. The ethical values of
the physician – compassion, competence, autonomy – apply to the
medical researcher as well. So there is no inherent conflict between
the two roles. As long as physicians understand and follow the basic
rules of research ethics, they should have no difficulty participating in
research as an integral component of their clinical practice.
Ethical requirements
The basic principles of research ethics are well established. It was
not always so, however. Many prominent medical researchers in the
19th and 20th centuries conducted experiments on patients without their
consent and with little if any concern for the patients’ well-being. Alt-