If patients are to be partners rather than subjects, contributing effectively to clinical research in which they have an interest, both they and investigators must change their ways. The case is argued here that the conduct of clinical research fulfils an essential need of society and that, therefore, in the interests of society, there is a moral imperative that it be done. Further essays will develop this theme, questioning along the way whether consent is a redundant concept.

In a series of articles, I argue for a different relationship between investigators and subjects of clinical research – one that is based on partnership in shared aims. This would require significant behavioural change since any relationship of this nature requires each partner to recognise their duties within it. This third essay examines the duties that would fall on patients in this partnership.

This series of articles argues for a different relationship between investigators and subjects of clinical research based on partnership in shared aims and recognition, by each, of their duties within this partnership. This second essay describes how those duties arise and explores the basis on which, and by and to whom, they are owed. The conclusion that patients have duties in research raises a number of moral issues which, ultimately, question the concept of consent. Discussion of these will be continued (...) in future articles. (shrink)

This series of articles have explored the need that society has for clinical research to be done and the consequent sets of duties that call on the one hand upon investigators to carry it out and on the other upon patients to be subjects of it. The purpose of the discussions has been to understand what should be the relationship between investigators and patient-subjects in order that both might meet their obligations effectively, efficiently, safely and with mutual respect. Here I (...) reach my conclusions. (shrink)

In these articles I have so far explored the set of duties that call upon patients to participate in clinical research as subjects of it. Here I consider whether they acquire a set of rights in consequence of participation, and what these rights may be.

In the first five of these articles I have questioned the justice, and effectiveness, of total dependence in clinical research on willing volunteers. I have explored ways that might better and more equitably spread the burden of participating in clinical research as subjects of it. Here I consider this question: if consent is the barrier, must we regard consent as indispensable?

What relationship between investigators and subjects of clinical research would best meet the needs and wants of both – and of society, which has an interest not only in clinical research being done but also in its being done well? This series of articles argues that investigators and subjects should work together in a partnership based in shared aims. Other relationships are possible, however, and here I examine two.

In a series of articles, I set out my belief that investigators and subjects of research should work together in a partnership based in shared aims. Such a relationship – quite different from what is usual today – would impose duties on both partners. In earlier papers I explored the origin and nature of the duties that would fall on patients; here I examine their limits.