RESEARCH IN EMERGENCY-MEDICINE - ETHICAL PROBLEMS

Having pointed out some curriculum goals in medical ethics, a plea is made for extensive animal experimentation, especially in emergency med icine in order to minimize necessary investigations in human beings. A lthough certain groups of patients (persons in custody, minors) are pr otected nowadays against unjustified research activities by legal rest raints, well-designed therapeutic (even non-therapeutic) investigative projects can be facilitated under certain conditions. The same attitu de might be adopted for ''special'' populations (e.g., HIV patients), which are very often excluded for various reasons. Research protocols and statistical evaluation should not be permitted to differ in these groups in comparison to ''normal'' patients. The issue of ''informed c onsent'' in emergency research with the main emphasis on resuscitation cannot be considered as resolved [39] since many patients are unconsc ious or at least incompetent. Irrespective of the number of legislativ e constructions proposed mainly in the USA (''proxy consent'', ''subst itute decision making,'' deferred consent'' - the latter being already declared a misnomer by its ''inventor'' [40]), ethical standards migh t better be adapted to the respective situations guided by competent e thical committees. As for the particulars of research protocols, rando mization combined with a blind or double-blind study design is now con sidered to be ethically desirable by a majority of authors, the same h olding true for risk stratification and sequential test procedures in order to reduce the number of patients required. The ''theory of intui tive thinking'' [18] is briefly touched upon as a futuristic investiga tive method and/or decision strategy. Summarizing the reflections pres ented, ''bioethics'', like any ethical system, cannot exceed an ancill ary function, thus never providing a moral seal of approval. In order to warrant qualified research the emergency physician must therefore b e prepared to ''live with uncertainty'' [33].