Ethical issues confronted in pulmonary clinical trials

Pulmonary clinical research possesses no unique ethical issues compared with other areas of medicine, but the range of disease states and conditions in pulmonary clinical research are broad. The ethical values guiding clinical research in pulmonary medicine are defined by the Belmont Report (i.e., patient autonomy, justice, and beneficence). This article uses some of the most well-known clinical trials in pulmonary medicine to illustrate these issues and the numerous perspectives that must be considered. Ethical issues covered include introduction of new surgical procedures, placebo controls and drug withdrawal designs, smoking status in trials of patients with chronic obstructive pulmonary disease, and the tensions between community practice, clinical care guidelines, and evidence-based medicine.