Virtue ethics of clinical research.

Sir,

A widely accepted idea of clinical science is that it seeks the truth and that the knowledge acquired should be of benefit to patients.[1] Therefore, as clinical researchers, we give response to two concerns deeply rooted in the human nature: The desire to know and the need to help someone suffering.[23] However, the ideas and values that sustain clinical research, and take it to its most genuine objectives, are subject to numerous tensions. For centuries, medicine has been gradually departing from its anthropocentric origin to become a political, social, and economic instrument.[3] It is difficult for researchers based in clinical settings to remain focused on human good when the clinical activity is distracted from it by so many issues. Currently, the lack of ethical references widely accepted by the scientific community makes the concepts of good, human life, or human health uncertain; we have been left with a reduced number of hesitant principles against the powerful forces of market and ideology.[3] Sometimes, the personal circumstances of the researcher, including the pressure to publish or attract income, increase the constraints imposed on research even more.[34] All these issues can blur the values that sustain research, undermine the objectivity, accuracy, and reliability of our studies, and can make the researcher adopt the role of a businessman or a bureaucrat, who conducts a type of research that is empty of its meaning.

A thorough exploration of the ends of our work and its ethical nature can help rediscover the values and ideas that should structure clinical research and lead to a scientific production of the highest quality. Ethics in the context of clinical research is nowadays dominated by principles and regulations,[5] which provide a manageable, sometimes simplistic, idea of the good, and demand very little personal engagement from the researcher.[3]

Virtue ethics is rooted in classical philosophy and fills many of the gaps on the intellectual framework, in which research is currently conducted.[236] Virtue ethics acknowledges that there is an ethical nature in all activities related to research (not only in ethical dilemmas), including the conceptualization of the studies, the distribution of work, and the way we treat the members of our team. Virtue ethics also revives the idea that all of us are naturally inclined to move toward what we perceive as good.[6] Virtues are the intellectual and moral qualities that we can acquire to define correctly and move effectively toward that ethical horizon; the qualities that take us to our natural ends, ultimately the qualities that make us good.[26] Ethics, based on virtues, is flexible as there are no preestablished solutions for specific questions, and the researcher has to deliberate the best way to look for the good in each specific circumstance. The ethical character of the researcher is thereby the ultimate guarantor of ethical excellence, and we cannot deflect our responsibility on a committee or the government. Virtue and principle ethics complement, balance, and enrich each other.

There are two main points that require practical action from the perspective of virtue ethics: The acquisition of the virtues needed to conduct scientific studies of the highest quality and the provision of a research community where these virtues can be constantly improved.[3] We cannot do any good to our patients if the evidence we report in our studies is weak. Ethical excellence therefore encompasses scientific excellence, which includes virtues such as being knowledgeable of the clinical principles and research methods, the capability to think critically, being open-minded, creative, disciplined, diligent, and focused.[7] However, the researcher who aims for ethical excellence must also work on virtues that go beyond the technical characteristics of a good scientist, for example, honesty, compassion, and some degree of self-effacement that allows to move not only for our own good.[1] The virtue of prudence is the one that articulates the other virtues and closes the gap between cognition of the good and motivation to do the good. We learn about virtue mostly from the example of a virtuous colleague, and we acquire virtues through hard work and practice.[36]

However, unless virtue ethics is based on a firm idea of the good, it becomes relativist and meaningless. Aiming to define the good that should motivate our research makes us face a number of fundamental questions including: What is a human being; where is human dignity based; and is there an ethical order transcending the human being? Modern man sometimes feels uncomfortable reflecting on or discussing these issues, but patients are very rarely skeptical about their own suffering and expect us to search for answers to all these questions. The current climate of moral skepticism and moral atomism is therefore unjustified.

The concept of the good, together with the realities of disease, suffering, and death is complex, and their understanding demands reflection and discussion on a diversity of ideas. Many scientists believe that things that cannot be verified experimentally do not deserve acknowledgment. These would include all ethical reflections. It seems clear to us that searching for the good and becoming a virtuous researcher requires an intellectual approach that goes beyond the traditional scientific methodology.

In conclusion, given the proximity of clinical research to the reality of disease, concurring an adequate training, and the necessary material means, the power of the clinical researcher to do good to different patients seems enormous. The moral imperative imposed by this fact goes beyond many political, economic, and social circumstances. Being a researcher is a privilege, hence ignoring our ethical commitment would be ungrateful. Ultimately, it would also be disloyal to the universal vocation to search and do the good. Our commitment as clinical researchers requires that we look for ethical excellence throughout our professional activity. A continued reflection, self-examination, and dialog with colleagues and society are required to understand the ethical nature of clinical research. Searching for the good in all steps of our practice gives clinical research its full meaning and researchers their maximum fulfillment.

Financial support and sponsorship

Luis Ayerbe is funded by a National Institute of Heath Research (NIHR) Clinical Lectureship. This article therefore presents independent research funded by the NIHR. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health. This project was conducted with no direct involvement from funders.

Conflicts of interest

There are no conflicts of interest.