


































Microsoft Word - Waseem Public Health


Bangladesh Journal of Bioethics 2016; 7(2):25-30 

 

25 

 

Review Article 

 

Ethics in Public Health Research and Clinical Research 

 

Muhammad Waseem Khan1, Afrasiab Khan Tareen2, Imrana Niaz Sultan2 

1.  Department of Biotechnology, Faculty of Life Sciences & Informatics, Balochistan  

2. University of Information Technology Engineering & Management Sciences (BUITEMS) 

Quetta Balochistan, Pakistan. 

Email: muhammad.waseem@buitms.edu.pk  mwaseem.tareen@yahoo.com   

 

Abstract: Research conducted with ethical values is the need of modern world and great benefit 

to the society in general and human beings in particular. Clinical research basically focuses on 

improving human health individually by improving current trends, methodologies and 

identifying innovative methods of treatment. Public health research is mainly concerned with the 

health of the entire populace. No standard rules can be formulated for conducting any form of 

research ethically; however following some basic ethical values can assure ethical conduct of 

research. In any research study whether that is public health research or clinical research, the 

importance is need to be to recognize an ethical standard that respects individual’s autonomy and 

community’s wellbeing. Ethical values in research studies can be achieved by requiring 

individual’s and community’s collective collaboration for the protection of individuals 

autonomy, dignity and wellbeing. 

 

Keywords: clinical research, public health research, bioethics, autonomy, justice 

 

Introduction: Research has been defined as an activity that is designed to test a hypothesis for 

the conclusions to be drawn for the development of new treatment and knowledge. Research 

promises great blessings of Science to human beings but, great care should be taken to ensure 

that it should not violate human dignity. For this purpose the researchers are ethically and 

morally bound to respect human life and people’s autonomy. Research ethics aims to achieve 

fundamental objectives of how we ought to act in any situation or scenario, and to provide strong 



Bangladesh Journal of Bioethics 2016; 7(2):25-30 

 

26 

 

reasons and justification for doing so. Research ethics plays an important role, striving to make 

possible that any research study is conducted after following the due ethical procedures1. 

 

Discussion: There is no standard way of organizing the ethics of public health, clinical practice 

and biomedical science. There are Some basic ethical concerns that are focused for both types of 

research whether that is public health research or clinical research to be ethical, the study design 

must be scientifically sound, it should have sufficient power to test the hypothesis etc. Although 

these distinguishing characteristic concerns are often captured under the broad umbrella term of 

bioethics, sometimes bioethics is presented as the equivalent of medical ethics or in contrast to 

population level bioethics or public health1. 

 

Public health research ethics object of concern is the whole populations, not individual human 

being, concerning to maximize welfare of the whole population. Public health research ethics 

follows a consequentialist approach that is promoting public health by seeking to improve good 

health and to avoid bad health outcomes of overall population. Promoting public health involves 

a high degree of commitment to the deterrence of disease focusing mainly on preventive aspect, 

involves diagnosing and treating illnesses, with all the attendant clinical services that those 

activities require. Public health addresses the fundamental causes of disease and requirements for 

health, aiming to prevent adverse health outcomes. On the other hand, clinical research refers to 

the subset of individual human subject’s research that focuses on improving well-being and 

human health, normally by identifying better methods to treat, or prevent individuals from 

diseases. The potential expected benefits of clinical research are only expectations based on 

hypothesis, but the risks and burdens of clinical research are present in the current study 

participants2. 

 

Public health research ethics has a broader spectrum than clinical research ethics, public health 

research is, as what we do as a society collectively to guarantee better conditions for people of 

society to be fit and healthy. The field of public health is concerned with disease prevention and 

health promotion throughout the society. Unlike clinical research, public health research is less 

interested in clinical interactions between health care professionals and the individual patient, 

and it is more interested in developing broader strategies to prevent diseases2, 3. 



Bangladesh Journal of Bioethics 2016; 7(2):25-30 

 

27 

 

 

In bio medical and clinical research ethics, much emphasis is placed on autonomy, the freedom 

of the individual human being but, in public health research ethics the focus is on the overall 

public. For public interest some measures might cause minor infringements of a person’s 

freedom but, that is to achieve significant benefits for a large number of people3. 

 

Two theories of ethical perspective have commonly been cited in the literature of public health 

research ethics and clinical research ethics. The duty based deontological theory of Immanuel 

Kant and the consequences based utilitarian theory of Jeremy Bentham and John Stuart Mills. 

Kantianism or deontological theories hold that indiviuals should not be treated just as mere 

means to an end and that some actions are judged right or wrong regardless of the results and 

consequences. Deontological theories based on duty provide robust support for defending 

research subjects as an individual and whole community of people of individuals; it strongly 

focuses individual’s autonomy and respect. Its great deal of focus is based on duty which asks 

for autonomy, individual respect and risk benefit ratio despite of consequences that may be great 

but, as far as these matters are concerned, it has to be followed in any and every case of clinical 

research ethics and other fields of life4.  

 

On the other hand for the benefit of community and public health research ethics the utilitarian 

theories focuses to maximize beneficial consequences regardless of any harm to individuals. The 

principle of utility requires aggregate or collective benefits rather than individual benefits to be 

maximized from study participants to the future population. It balances the current risks and 

potential harm to individual’s autonomy and individual respect with the benefits for future 

population. From a utilitarian perspective, based on utility the principle of utility is the ultimate 

ethical principle of concern that is focused to derive all other principles. Utilitarian theories 

provide strong justification and support for public health research programs such as obligatory 

vaccination programs for the safety of public health particularly children and the drinking water 

fluoridation of public water sources and public water supply system, which may be of no benefit 

or even harm to some individuals in that specific population or society2, 4. 



Bangladesh Journal of Bioethics 2016; 7(2):25-30 

 

28 

 

As it is broadly understood, that public health research is concerned with promoting and 

protecting the health of populations. Public health research is mainly concerned with the health 

of the whole population as an aggregate, rather than the health of individuals. Public health 

research emphasize on the prevention of diseases and promotion of overall public health. In 

developing effective interventions it interacts with behavioral, social, biological, environmental 

and economical factors4. 

The foundation of public health research ethics is social justice contributing to the society. 

Balancing individual’s liberty and autonomy has been the main ethical issue in public which is 

not addressed due to its broader scope for society that causes inequality. On the other hand the 

fundamental ethical concern raised by clinical research ethics is whether and when it can be 

acceptable to expose some individual to risks and burdens for the benefit of others. The answer 

to this question depends crucially on the benefits to future population, and their relationship to 

those who are being currently exposed to the risks participating in the current research study2, 4. 

In clinical research ethics, risk and benefit ratio is assessed focusing on the current patient. To 

asses, whether to harm someone for the future benefits of others or for future population is 

ethically and morally acceptable or not, while public health research ethics assess risk and 

benefits ratio for the benefits of future population and society as whole. From clinical research 

ethics perspective the issues will probably remain even after having a valid inform consent from 

the participant as inform consent does not remove the associated risks but only a procedure to be 

followed. The participant may face some risks due to new intervention, the risks which may not 

be avoided even after testing has occurred in the laboratory, and in animals5, 6. 

Clinical research ethics concerns with the issue of therapeutic misconceptions, the distinction 

between clinical care and clinical research which arises between researcher who is the physician 

and the participant who is the patient for the physician participating in that research study. In any 

clinical research the patient sometimes participates in the research study due to his physician 

involved in that study. Sometimes the patients misconceive the research as the treatment. The 

inquiry of how to discriminate between research and treatment is still a grey area that is to be 

focused. On the other side in public health research ethics the issue of therapeutic misconception 

may not be of great deal but still cannot be totally neglected, there are fewer chances of 



Bangladesh Journal of Bioethics 2016; 7(2):25-30 

 

29 

 

therapeutic misconceptions that still remain. Some people worry that doctors conducting 

randomized controlled trials studies confront situations of dilemma in clinical research ethics; on 

the grounds that offering patients access to a trial in which they have a high chance of receiving 

placebo or no treatment seems to involve the doctor in prescribing and recommending treatment 

of suboptimal nature to his own patient5, 6. In any research study whether that is public health 

research or clinical research, it is important to recognize an ethical standard that respects 

individual’s as well as community’s autonomy. It can be achieved by requiring individual’s and 

community’s collaboration to protect against exploiting vulnerable populations, to ensure fair 

terms of cooperation, and to minimize potential misunderstandings about the research5, 7, 8. 

Conclusion: The four basic ethical principles of justice, beneficence, nonmaleficence and 

respect for individual’s autonomy can be used as a scaffold for ethical decision making in any 

form of research. These principles ensures individual’s and community’s dignity, researchers 

obligations to individual and community, avoiding and disclosing conflicts of interest, 

minimizing risks and providing benefits, privacy and confidentiality that all are the fundamentals 

of every research study. 

Acknowledgement: The authors would like to acknowledge the generous support and guidance 

of Dr. Arshi Farooqui, Aga Khan University Hospital, Karachi, Pakistan. 

 

Competing interests: The authors declare that they do not have any competing interests. 

 

Funding: The Authors declare that the current study was not funded 

 

Authors’ contributions: All authors have contributed substantially to the conception and design 

of the manuscript. Muhammad Waseem Khan is the 1st and corresponding author. Afrasiab Khan 

Tareen, and Imrana Niaz Sultan are 2nd authors and they have contributed equally. Muhammad 

Waseem Khan has critically revised the manuscript. All authors have read and approved the final 

manuscript. 

 

 

 



Bangladesh Journal of Bioethics 2016; 7(2):25-30 

 

30 

 

References:  

1. Kalantri, SP. Ethics in clinical research. Indian Journal of anesthesia 2003; 47(1): 30-32. 

2. Beauchamp T, Childress J. Principles of biomedical ethics. Oxford University Press, 5th 

edition, New York; 2001. 

3. Krebs J. The importance of public-health ethics.  Special theme – Ethics and public 

health: Bulletin of the World Health Organization 2008; 86 (8). 

4. Coughlin, SS. Ethical issues in epidemiologic research and public health practice. 

Emerging Themes in Epidemiology 2006, 3:16. 

5. Kevin, P et al. Disclosure of Financial Relationships to Participants in Clinical research. 

N Engl J Med 2009; 361(9): 916–921. 

6. Khan MW, Sultan IN, Khan A, Khan MB. Issues of research ethics and clinical ethics in 

developing world, Possible Solution: a way forward. Bangladesh journal of Bioethics 

2012; 3(3):12-15. 

7. Buchanan DR, Miller FG. A Public health perspective on research ethics. J Med Ethics 

2006; 32:729-733. 

8. Khan MW, Khan SZ, Khan A, Sultan IN. Standard of Care in Clinical Research 

Involving Human Subjects: A Perspective from Developing World. Bangladesh journal 

of Bioethics 2014; 5(2):68-72. 

 

 

 


