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                                                                                         Bangladesh Journal of Bioethics 2018; 9(2):22-25 

 

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Public Health Research Ethics and Clinical Research Ethics. How we 

differentiate? 

Zoheb Rafique 

Department of Community Medicine, Liaquat University of Medical & Health Sciences 

(LUMHS), Jamshoro, Pakistan 

Email: scorpionzoheb@hotmail.com  

 

Abstract: This article talks about both clinical research ethics and public health research ethics. 

Clinical research ethics are defined as set of relevant ethics considered necessary for the conduct 

of clinical trials in field of the clinical research. While public health research ethics is mainly 

aimed at finding out what is best for the communities and the populations rather than the 

individuals. Research ethics is mainly focused on the protection of individual participants and 

some of the research norms and accepted principles may be challenging when applying in some 

of the research contexts. 

Key words: Public Health; Research Ethics; Clinical Research Ethics 

Introduction: The field of biomedical ethics 

arose in late 1960s in response to some 

emerging ethical dilemmas and issues of that 

era. This field for many years focused on 

dilemmas generated by the high technology 

medicine, rather than on the issues of the 

population health and the ethical problems of 

public health programs. The discipline 

Bioethics received the initial stimulus from 

abuses and issues of human subject’s 

research, also the emergence of patient’s 

rights movement, and the drama of high 

technology medicine. The Research 

involving human subjects has often been a 

central ethical issue and problem for the 

biomedicine for at least hundred (100) years 

now, and particularly since the World War 2. 

Just as the public health is broad in the scope, 

the range of the ethical issues in this field is 

uncommonly wide (1). In past twenty (20) 

years, the research base of the clinical ethics 

has gained tremendous strength appreciably. 

However the main research opportunities 

didn’t come under broad heading of the 

clinical ethics, but instead through the 

specific programs such as human genome 

project and end of life movement (2). In this 

paper, I will discuss the differences between 

public health research ethics and clinical 

research ethics. 

Discussion: The Public health research ethics 

include ethics regarding the community 

participation in the research, while the 

clinical research ethics include the ethics 

regarding the clinical patient research. This is 

major difference between these two 

scenarios, now I will discuss it in detail. Most 

of the research has focused on the clinical and 

the experimental medicine (efficacy, safety 

and the mechanism of action, and also 

regulatory issues regarding general neglect of 

the public health dimensions. The Public 

health ethics, which is defined as 

identification, analysis, and the resolution of 

the ethical problems occurring in the public 

health practice and also public health 



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research. It has different domains than those 

of the medical ethics. The ethical concerns in 

the public health often relate to dual 

obligations of the public health professionals 

to apply and acquire the scientific knowledge 

that aimed at restoring and also protecting 

public health while respecting the individual 

autonomy. Ethics in the public health 

involves interplay between safeguarding 

welfare of individual, as in medicine, and 

also the public health goal of protecting 

public welfare. Some other ethical concerns 

in the public health relate to need to ensure 

just and fair distribution of the public health 

resources. The Public health ethics has broad 

scope that includes the ethical and the social 

issues arising in the health promotion and the 

disease prevention, the epidemiological 

research, and also public health practice. The 

main professional roles of the 

epidemiologists are design and the conduct of 

the scientific research and public health 

application of the scientific knowledge. This 

includes reporting the research results and 

also maintaining and promoting the health in 

communities. It also functions in carrying out 

the professional roles. The epidemiologists 

often encounter many ethical issues and some 

concerns that require the careful 

consideration. Many of those issues have 

been highlighted and addressed in literature 

on ethics in the epidemiology and public 

health including the ethics guidelines. The 

ethical and the professional norms in the 

epidemiology have also been clarified in the 

ethics guidelines for the epidemiologists and 

also the public health professionals. The 

Ethics guidelines such as those developed for 

Industrial Epidemiology Forum, 

International society for the Environmental 

Epidemiology, and American college of the 

Epidemiology also provide useful accounts 

of the epidemiologists’ obligations to the 

research participants, employs, society, and 

colleagues (3). The Epidemiological studies 

can provide the descriptive data that can lead 

scientists in the future to develop some 

interventions that can result in the reduction 

in morbidity and mortality; the health 

education program can be one of the multiple 

interventions that together reduce the risks 

and ill health. The argument here, however, 

is that the public health programs, studies, or 

interventions, must be designed with the 

awareness of relationship between that 

program and ultimate reduction in the 

morbidity and mortality. The Public health 

programs may result in high employment, as 

well as some less tangible benefits such as 

coalition building and strengthening of the 

communities. Today, the public health 

practitioners use some tools in addition to the 

epidemiology to register their work, still 

aiming primarily on community wide. It also 

typically uses prospective methods and 

approaches to improve health. In addition, 

the practitioners investigate the outbreaks, 

provide health education, conduct contact 

tracing, and some other preventive 

interventions, and also organize research 

related to the public health (4). The Public 

health agencies require the identifiable health 

information for conducting different public 

health activities. The increasing number of 

the functions, including the public health 

surveillance, and outbreak and incident 

investigations and program implementation, 

and some direct health services, such as the 

clinical public health activities and services 

and the research, maintenance, and the 



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storage of the personal health information. 

The Successful execution of all these 

functions depends on the data quality and the 

accessibility. Heightened security is very 

necessary and paramount to maintain the 

public confidence; also good health care and 

it depends on the patients providing the 

accurate and sensitive information to their 

care providers in a very timely manner. 

Placing restrictions on the data acquisition, 

use, and the disclosure also poses some risks, 

particularly if those restrictions impede 

acquisition of the key surveillance data, 

which would otherwise be used to prevent the 

disease, investigate the causation, and enable 

the interventions to protect the exposed 

population. Additionally, electronic data 

could potentially permit real time public 

health surveillance and also can facilitate the 

faster emergency response (5). Advances in 

the science, technology and the biomedical 

research have pushed the boundaries of 

Belmont principles and stimulating the need 

for the communities to be involved in 

informed consent process. Changes in the 

Food and the Drug Administration 

regulations allow the waivers of the informed 

consent in life threatening emergencies. The 

rights of the unconscious participants are 

assumed to be accorded degree of the 

protection through mechanism of the 

“Community Consultation” which requires 

the prior consultation by the investigators and 

the institutional review boards with the 

community representatives and public 

disclosure to affected community both before 

and after that research (6). Now I will discuss 

the clinical research ethics, and we will see 

how it is different from public health research 

ethics. Taking into account the sound and the 

increasing emphasis of recent years that the 

experimentation in man must precede the 

general application of the new procedures in 

the therapy, and also there is reason to fear 

that these requirements and the resources 

might be greater than supply of the 

responsible investigators. Medical schools 

and the university hospitals are increasingly 

dominated by the investigators. Every young 

man knows that he will never be promoted to 

some tenure post, and to a professorship in a 

major medical school, unless he has proved 

himself as an investigator. If the ready 

availability of the money for conducting the 

research is added to this fact, one can see how 

great the pressure is on the ambitious young 

physicians (7). A taxonomy was developed 

for the clinical ethics research, based on the 

method rather than the clinical area. This 

divided research in different terms of whether 

it used theoretical or any empirical methods. 

First, we will see the theoretical methods of 

the clinical ethics research. Philosophy (e.g., 

How should the decisions on setting the 

priorities be made legitimate and also fair?). 

Law (e.g., what practices in setting the 

priorities in regional health authority might 

constitute discrimination?). Policy (e.g., what 

policy should the governments follow in 

funding the new technologies in medicine?). 

Now let’s see the empirical methods of 

clinical ethics research. Social Sciences (e.g., 

how do the regional health authorities in the 

developing countries make the decisions on 

setting the priorities?). Decision analysis 

(e.g., How do you trade-off considerations of 

equity and efficiency in the decisions on 

setting priorities?). Clinical epidemiology 

(e.g., what are the criteria used to allocate the 

liver transplant?). Health services research 



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(e.g., how does the delivery of the cardiac 

surgery vary by patient gender and 

ethnicity?). Within empirical research, there 

is some growing recognition that the 

quantitative methods alone are not adequate. 

Since many of the phenomena examined by 

the ethics researchers are deeply entwined 

into fabric of professions, organizations, and 

the human lives, qualitative methods have 

begun to play an important role. For example, 

one investigator performed the observational 

research on how physicians discuss do-not-

resuscitate orders and also advance care 

planning. The role of the qualitative methods 

is increasing to include not only the content 

analysis but also grounded theory, the 

ethnography, and the case study designs. 

When we review the field of the clinical 

ethics a decade from now, we hope that the 

focus will be shifted from the ethics courses, 

committees and the consultants to an 

understanding on the part of most physicians 

and medical students that ethics is an inherent 

and inseparable part of the good clinical 

medicine. We hope that clinical ethics will 

achieve its rightful place at the interstices of 

relations between the patients who are sick 

and physicians who profess to be able to heal 

and comfort them. Clinical ethics has made 

progress towards this vision in the past some 

years. The challenge remains for the research 

to become a mainstream concern for the 

funding agencies around the World.  

Conclusion: In conclusion, it is stated that 

although public health research and clinical 

research are different from each other, but 

ethical dilemmas are faced by both and also 

they are same in many situations. While 

considering the public health research ethics, 

the researcher must show respect for culture 

of the community, also take community input 

on the protocol development, and ensure that 

research is useful to community, and should 

respect the knowledge and experience of the 

community, and ensure that the informed 

consent is correctly taken before starting any 

of the research (8). While considering the 

clinical research ethics, two components are 

most important. The first being the informed 

consent, and the statement that informed 

consent has been obtained has very little 

meaning unless the participant or his/her 

guardian is capable of understanding what is 

to be undertaken and all of risks/benefits are 

explained clearly. Secondly, there is more 

reliability provided by the presence of 

intelligent, informed, compassionate, 

conscientious, and responsible investigator. 

References: 

1. Daniel Callahan and Bruce Jennings. Ethics and 

Public Health: Forging a Strong Relationship. 

American Journal of Public Health. 2002; 92(2): 169-

176. 

2. Peter A Singer Et Al. Clinical Ethics Revisited. 

BMC Medical Ethics. 2001; 2:1. 

3. Steven S Coughlin. Ethical issues in epidemiologic 

research and public health practice. Emerging Themes 

in Epidemiology. BioMed central. 2006; 3:16. 

4. Nancy E. Kass. An Ethical Framework for Public 

Health. Public Health Matters. 

5. Julie Myers Et Al. Privacy and Public Health at 

Risk: Public Health Confidentiality in the Digital Age. 

American Journal of Public Health. 2008; 98(5): 793-

801. 

6. Sandra Crouse Quinn. Protecting Human Subjects: 

The Role of Community Advisory Boards. American 

Journal of Public Health. 2004; 94(6): 918-922. 

7. Henry K. Beecher. Ethics and Clinical Research. 

The New England Journal of Medicine. 1966; 

274(24): 1354-1360. 

8. C. Weijer and E.J. Emanuel. Protecting 

Communities in Biomedical Research. Science. Policy 

Forum: Ethics. 2000; 289: 1142-1144