Performing acute care-oriented research in geographic settings with limited resources may be ethical if the population’s basic survival needs are being met, according to investigators of a case scenario published in the AMA Journal of Ethics.

This theoretic case presents the work of a medical student, Jenny, who is set to conduct a study on congenital heart disease in a developing country. Many members of her host family go without a portion of drinking water, which is rare in the geographic area, so that the medical student can also have access to fresh drinking water. The medical student in this scenario begins to contemplate the ethical considerations associated with developing interventions for heart disease in this population.

Anwar Jackson, MD, of Hurley Medical Center and Michigan State University College of Human Medicine in Flint, Michigan, notes that this ethical dilemma is common in research focused on communities in developing countries and may grow in the next 20 years. Beneficence, which focuses on maintaining the welfare of research participants, is a key factor essential for communities with limited resources.

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In this case, Jenny displays beneficence but currently lacks distributive justice, which focuses on keeping community resources allocated appropriately for research participants. Thus, many researchers today are faced with choosing between performing research that may ultimately improve outcomes in specific populations vs keeping current resources in these populations balanced to ensure basic needs are being met.

According to the Dr Jackson, the successful implementation of distributive justice and beneficence into research of the host community “can be the catalysts for both short-term and long-term positive change in that host community.”

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In an additional commentary, Harold W. Neighbors, PhD, also of Michigan State University College of Human Medicine, in Flint, Michigan, adds that medical students can conduct research that places medicine within the context of public health and community-based participatory research. Public health physician-scientists must “invite community members to help shape research proposals, and they must insert themselves into the health policy process.”


Jackson AD, Neighbors HW. Is acute care-oriented research ethical in resource-limited settings? AMA J Ethics. 2017;19(10):978-988.