Intended for healthcare professionals


Beyond Helsinki: a vision for global health ethics

BMJ 2001; 322 doi: (Published 31 March 2001) Cite this as: BMJ 2001;322:747

Improving ethical behaviour depends on strengthening capacity

  1. Peter A Singer, Sun Life chair and director (,
  2. Solomon R Benatar, professor of medicine
  1. University of Toronto Joint Centre for Bioethics, Toronto ON, Canada M5G 1L4
  2. University of Cape Town, Observatory 7925, Cape, South Africa

    The fifth revision of the 1964 Declaration of Helsinki, published in October 2000, sets out international standards for conducting medical research with human subjects.1 Revisions of this or any other research ethics code are unlikely to make research more ethical throughout the world, however, without some means of strengthening capacity to promote and implement such standards.

    Strengthened capacity in research ethics is needed in both developed and developing countries, though the need is particularly acute in developing countries. A recent Washington Post investigation into research in developing countries revealed “a booming, poorly regulated testing system that is dominated by private interests and that far too often betrays its promises to patients and consumers.”2

    Research in developing countries was a flash point of the fifth revision of Helsinki because the declaration retains the requirement that new treatments should be tested against the “best current” treatment. Critics argue that this standard does not allow the testing of low cost, sustainable treatments, such as aspirin for coronary artery disease, which might yield substantial health improvements in developing countries but …

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