Post-trial obligations in the Declaration of Helsinki 2013: classification, reconstruction and interpretation

Dev World Bioeth. 2016 Aug;16(2):80-90. doi: 10.1111/dewb.12099. Epub 2015 Oct 19.

Abstract

The general aim of this article is to give a critical interpretation of post-trial obligations towards individual research participants in the Declaration of Helsinki 2013. Transitioning research participants to the appropriate health care when a research study ends is a global problem. The publication of a new version of the Declaration of Helsinki is a great opportunity to discuss it. In my view, the Declaration of Helsinki 2013 identifies at least two clearly different types of post-trial obligations, specifically, access to care after research and access to information after research. The agents entitled to receive post-trial access are the individual participants in research studies. The Declaration identifies the sponsors, researchers and host country governments as the main agents responsible for complying with the post-trial obligations mentioned above. To justify this interpretation of post-trial obligations, I first introduce a classification of post-trial obligations and illustrate its application with examples from post-trial ethics literature. I then make a brief reconstruction of the formulations of post-trial obligations of the Declaration of Helsinki from 2000 to 2008 to correlate the changes with some of the most salient ethical arguments. Finally I advance a critical interpretation of the latest formulation of post-trial obligations. I defend the view that paragraph 34 of 'Post-trial provisions' is an improved formulation by comparison with earlier versions, especially for identifying responsible agents and abandoning ambiguous 'fair benefit' language. However, I criticize the disappearance of 'access to other appropriate care' present in the Declaration since 2004 and the narrow scope given to obligations of access to information after research.

Keywords: benefit sharing; health care after research; information after research; moral obligation; post-trial access ethics; research ethics; right to health.

MeSH terms

  • Clinical Trials as Topic / ethics*
  • Ethics, Research*
  • Helsinki Declaration*
  • Human Experimentation / ethics*
  • Humans
  • Practice Guidelines as Topic
  • Research
  • Terminology as Topic