Universal compulsory service in medical research.

Despite the prominence of healthcare-related concerns in public debate, the ground remains infertile for the idea of conscripting citizens into medical research. Reluctance to entertain the thought of a system where nearly everyone could be selected for service might reflect uncertainty about what the project would involve. There might also be a fear that the more crucial issue is how to protect research subjects within current, voluntary systems. No doubt reluctance to explore a system of universal service results from the common hope that each of us might avoid research in any capacity besides researcher. A system of full civic participation might, however, avoid many of the usual objections. Ethics regulations, including informed-consent guidelines, could for the most part remain in force. Though the system would compel people to serve, it could remain responsive to principles of autonomy and justice if it centered on broad public education, community representation, and a lottery-type selection process. The system could draw from the largest possible cross-section of society, and offer conscripts the widest possible range of service. In this way, a compulsory system might reconcile the expectations about healthcare with research needs.