A normative justification for distinguishing the ethics of clinical research from the ethics of medical care

The central question in current debates about the moral appropriateness of randomized placebo-control trials and the principle of clinical equipoise for research is whether physician-researchers owe primary loyalty to their patient-subjects, as physicians owe their patients under medical care. We argue that they do not. First, because of the importance of medical research and the scientifically rigorous means needed to produce valid medical knowledge, there is prima facie reason to exclude the duty of therapeutic beneficence from the duties on researchers. Second, that prima facie reason is not trumped by the reasonable expectations of patient-subjects.