Nowhere is the potential for conflicting obligations more worrisome than in situations where doctors simultaneously deliver medical care to patients and use them as research subjects.

The idea of experimenting on patients conjures up two quite different pictures. The first depicts persons who are sick and suffering—perhaps even dying—being subjected to the manipulations of clinical investigators who use patients in their efforts to contribute to scientific knowledge, as well as to promote their own careers. The second picture portrays untold numbers of present and future patients receiving the benefits of miraculous cures resulting from painstaking research in hospitals and laboratories. Neither of these pictures is an accurate rendering of the actual conduct of research involving human subjects, yet both contain partial truths.

The actual contribution to medical knowledge gained by most clinical trials is only a pale rendering of the image of miraculous breakthroughs in scientific understanding and control of...

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