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Do doctors have a duty to take part in pragmatic randomised trials?

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2817 (Published 14 June 2017) Cite this as: BMJ 2017;357:j2817
  1. Marion K Campbell, professor of health services research1,
  2. Charles Weijer, professor of philosophy and medicine2,
  3. Cory E Goldstein, doctoral student2,
  4. Sarah J L Edwards, senior lecturer in research ethics and governance3
  1. 1Health Services Research Unit, University of Aberdeen, UK
  2. 2Rotman Institute of Philosophy, Western University, Canada
  3. 3University College London, UK
  1. Correspondence to: M K Campbell m.k.campbell{at}abdn.ac.uk, C Weijer cweijer{at}uwo.ca

For society to benefit from new clinical knowledge the expectation should be to participate in research, writes Marion K Campbell; Charles Weijer and colleagues agree but argue that the fundamental need for consent makes this an imperfect duty

Yes—Marion K Campbell

Doctors require knowledge of the potential benefits and harms of different treatment options to inform clinical decision making. Patients also require this information to make an informed choice between different treatment options. This knowledge base is generated from robust clinical research such as randomised controlled trials. For this knowledge base to advance, doctors and patients must be willing to take part in studies.

Randomised trials are the most rigorous way to evaluate effectiveness because they aim to compare interventions fairly.1 Many trials have shown that treatments that were thought to be beneficial before rigorous testing were actually of minimal benefit or harmful (for example, oxygen therapy in acute myocardial infarction2). Pragmatic randomised trials evaluate treatments as they are delivered in routine clinical practice, aim to answer clinically relevant questions, and directly inform clinical decision making.3

Trials can occur only if doctors and patients take part—without their involvement, this knowledge would not exist. Doctors routinely use, and their knowledge benefits directly from, information gathered from trials (for example, when using evidence based clinical guidelines).

Everyone benefits

If society wishes healthcare to improve, doctors and patients must continue to participate in such endeavours. There is also the concept of reciprocity: if you benefit from other people’s participation then you have a duty to reciprocate,4 especially in a publicly funded health system such as the UK’s NHS. Some ethicists go further and argue that we all have a moral obligation to take part in medical research because its aim is to significantly benefit humankind (grounded in the concepts of beneficence …

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