Research on critically ill and injured patients: rules, reality, and ethics.

Much of today's medical care relies on experience unsupported by investigation, and emergency medical care is no exception; research is necessary to improve this care. Critically ill and injured patients are the patients who will benefit the most from improvements in emergency medical diagnostic and treatment methods. Yet, the federal bureaucracy has effectively banned research on these patients, since they cannot generally give "informed consent." We argue that, with the proper safeguards, research on critically ill and injured patients should be performed in the emergency medicine (EDs and EMS) settings without informed consent. To require such consent when not obtainable compromises both the researchers who must get such consent and the patients who must continue to endure old, and often untested therapies.