Coexisting Commitments to Ethics and Human Research: A Preliminary Study of the Perspectives of 83 Medical Students

Human research is accepted in our society because it is seen as generating valuable new knowledge that may alleviate suffering and bring benefit to ill persons now and in the future (Brody 1998; Faden 1996; National Commission for the Protection of Human Subjects 1979). Performing research that involves human participants is ethically complex, however, and ethical and scientific considerations in human research historically have been viewed as being in tension (Freedman 1987; Michels 1999). Some have asserted that ethical restrictions, while necessary, directly impede scientific progress (Woodward 1999). Controversies in human research ethics have centered on ethical safeguards as burdensome, disproportionate, and distorting of scientific findings (Brody 1998; Edlund et al. 1985; Faden 1996; Gray 1975; Katz 1972). The past half-century, furthermore, provides many tragic examples of disregard for ethical principles and practices in the search for scientific progress (Beecher 1966; Katz 1996). Ethics and human research thus have been seen as uncompanionable and opposing forces (Faden 1996). A new view appears to be emerging in which ethics and human research are understood as significant coexisting commitments (Roberts 2002). Engaging in human research is itself seen as an ethical duty in this paradigm, and optimal scientific approaches may be reliant on the adoption of optimal ethical practices (Fried 2001). This new model of the relationship between science and ethics reinvigorates interest in recurring questions related to the ethical role of scientific design, the value of human research safeguards, whether ethical considerations are seen as detracting from scientific endeavors, under what circumstances ethically problematic research would be tolerated if the results were scientifically valuable, and the fundamental legitimacy of ethical controversies in human research (Brody 1998). These issues have been articulated over several decades in the published literature, but few data exist regarding the attitudes of stakeholders in the research process toward the relationship between science and ethics (Sung et al. 2003). Attitudes regarding the importance of ethics in the professions also have evolved in recent years and it is unknown how physicians-in-training perceive scientific and ethical considerations in human research (Wenger et al. 1997). The perspectives of these early career health professionals are important, however, as they will serve as investigators who conduct human studies, will facilitate protocols in diverse roles as clinicians, academic physicians, and reviewers of human research projects, or will provide care that is informed by evidence derived from human research (Braxton et al. 2001). Empirical ethics studies involving medical students have revealed their sensitivity to nuanced ethical issues in clinical training and practice and suggest strong levels of interest in ethics, especially among women physicians-intraining (Green et al. 1995; Hayward et al. 1985; Roberts et al. 1996). A survey of 2,010 clinical and basic science trainers in 1990 found that 11% had had formal preparation on research ethics (Kalichman and Friedman 1992). To our knowledge, however, no published studies have specifically examined attitudes of early career health professionals toward the relationship of scientific and ethical considerations in human research. For this reason, we performed a preliminary study of medical students’ perspectives on this topic area as part of a sequence of studies that examined ethically important issues in human research from the perspectives of key stakeholders, including clinical research participants, clinical investigators, clinicians, and physicians-in-training.