Clinical research in a public health crisis: the integrative approach to managing uncertainty and mitigating conflict.

In order to advance science while preserving social solidarity and institutional trust, clinical research must carefully manage ethical tensions created by the two overlapping dynamics of conflict and uncertainty. One of these dynamics is inherent in the research enterprise itself and the other arises in the particular context of a public health emergency. One test for both the moral soundness and practical utility of a framework for research ethics is its ability to help stakeholders understand and manage these ethical tensions as much as possible. After clarifying the dynamics that give rise to these tensions, this paper argues that two common approaches to evaluating clinical research have significant shortcomings in this regard. This paper then sketches and defends the integrative approach to managing these tensions.