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Researcher as Witness

Evaluation of clinical practice is quite well established. Since the 1950s, investigators have been using epidemiological methods to assess interventions and procedures. The field of clinical epidemiology now has many practitioners who are constantly expanding the scope of their studies. While the purview of clinical evaluation has consistently broadened, some rather striking ethical issues it raises have not been carefully considered. One of these is the situation in which a clinical investigator uncovers practices that may be harmful to patients. Clinical investigation avoids any disturbance of the practices under investigation. The researcher is pledged to confidentiality. Moreover, the clinical investigator usually lacks any relationship whatsoever with particular patients. In many cases, there is no consent sought from the patient. Therefore, if a researcher uncovers cases in which patients may be injured, and he could address these problems so as to prevent further injury, an ethical dilemma arises. Should the researcher break confidentiality, potentially jeopardize the study, and contact patients with whom he has no relationship? This kind of question could frequently trouble investigators in the future, as clinical investigation grows more ambitious, especially in quality