DECLARATION OF HELSINKI

- ethical principles for medical research involving human subjects

Preamble

1. The World Medical Association (WMA) has developed the Declaration of Helsinki as a statement
of ethical principles for medical research involving human subjects, including research on identifiable
human material and data.The Declaration is intended to be read as a whole and each of its constituent
paragraphs should be applied with consideration of all other relevant paragraphs.

2. Consistent with the mandate of the WMA, the Declaration is addressed primarily to physicians.
The WMA encourages others who are involved in medical research involving human subjects to adopt
these principles.

General Principles

3. The Declaration of Geneva of the WMA binds the physician with the words, “The health of my
patient will be my first consideration,” and the International Code of Medical Ethics declares that, “A
physician shall act in the patient’s best interest when providing medical care.”

4. It is the duty of the physician to promote and safeguard the health, well-being and rights of
patients, including those who are involved in medical research. The physician’s knowledge and
conscience are dedicated to the fulfilment of this duty.

5. Medical progress is based on research that ultimately must include studies involving human
subjects.

6. The primary purpose of medical research involving human subjects is to understand the causes,
development and effects of diseases and improve preventive, diagnostic and therapeutic interventions
(methods, procedures and treatments). Even the best proven interventions must be evaluated
continually through research for their safety, effectiveness, efficiency, accessibility and quality.

7. Medical research is subject to ethical standards that promote and ensure respect for all human
subjects and protect their health and rights.

8. While the primary purpose of medical research is to generate new knowledge, this goal can never
take precedence over the rights and interests of individual research subjects.

9. It is the duty of physicians who are involved in medical research to protect the life, health,
dignity, integrity, right to self-determination, privacy, and confidentiality of personal information of
research subjects. The responsibility for the protection of research subjects must always rest with the
physician or other health care professionals and never with the research subjects, even though they
have given consent.
10. Physicians must consider the ethical, legal and regulatory norms and standards for research
involving human subjects in their own countries as well as applicable international norms and standards.
No national or international ethical, legal or regulatory requirement should reduce or eliminate any of
the protections for research subjects set forth in this Declaration.

11. Medical research should be conducted in a manner that minimises possible harm to the
environment.

12. Medical research involving human subjects must be conducted only by individuals with the
appropriate ethics and scientific education, training and qualifications. Research on patients or healthy
volunteers requires the supervision of a competent and appropriately qualified physician or other health
care professional.

13. Groups that are underrepresented in medical research should be provided appropriate access to
participation in research.

14. Physicians who combine medical research with medical care should involve their patients in
research only to the extent that this is justified by its potential preventive, diagnostic or therapeutic
value and if the physician has good reason to believe that participation in the research study will not
adversely affect the health of the patients who serve as research subjects.

15. Appropriate compensation and treatment for subjects who are harmed as a result of
participating in research must be ensured.

Risks, Burdens and Benefits

16. In medical practice and in medical research, most interventions involve risks and burdens.
Medical research involving human subjects may only be conducted if the importance of the objective
outweighs the risks and burdens to the research subjects.

17. All medical research involving human subjects must be preceded by careful assessment of
predictable risks and burdens to the individuals and groups involved in the research in comparison with
foreseeable benefits to them and to other individuals or groups affected by the condition under
investigation. Measures to minimise the risks must be implemented. The risks must be continuously
monitored, assessed and documented by the researcher.

18. Physicians may not be involved in a research study involving human subjects unless they are
confident that the risks have been adequately assessed and can be satisfactorily managed. When the
risks are found to outweigh the potential benefits or when there is conclusive proof of definitive
outcomes, physicians must assess whether to continue, modify or immediately stop the study.
Vulnerable Groups and Individuals

19. Some groups and individuals are particularly vulnerable and may have an increased likelihood of
being wronged or of incurring additional harm. All vulnerable groups and individuals should receive
specifically considered protection.

20. Medical research with a vulnerable group is only justified if the research is responsive to the
health needs or priorities of this group and the research cannot be carried out in a non-vulnerable
group. In addition, this group should stand to benefit from the knowledge, practices or interventions
that result from the research.

Scientific Requirements and Research Protocols

21. Medical research involving human subjects must conform to generally accepted scientific
principles, be based on a thorough knowledge of the scientific literature, other relevant sources of
information, and adequate laboratory and, as appropriate, animal experimentation. The welfare of
animals used for research must be respected.

22. The design and performance of each research study involving human subjects must be clearly
described and justified in a research protocol. The protocol should contain a statement of the ethical
considerations involved and should indicate how the principles in this Declaration have been addressed.
The protocol should include information regarding funding, sponsors, institutional affiliations, potential
conflicts of interest, incentives for subjects and information regarding provisions for treating and/or
compensating subjects who are harmed as a consequence of participation in the research study. In
clinical trials, the protocol must also describe appropriate arrangements for post-trial provisions.

Research Ethics Committees

23. The research protocol must be submitted for consideration, comment, guidance and approval to
the concerned research ethics committee before the study begins. This committee must be transparent
in its functioning, must be independent of the researcher, the sponsor and any other undue influence
and must be duly qualified. It must take into consideration the laws and regulations of the country or
countries in which the research is to be performed as well as applicable international norms and
standards but these must not be allowed to reduce or eliminate any of the protections for research
subjects set forth in this Declaration. The committee must have the right to monitor ongoing studies.
The researcher must provide monitoring information to the committee, especially information about
any serious adverse events. No amendment to the protocol may be made without consideration and
approval by the committee. After the end of the study, the researchers must submit a final report to the
committee containing a summary of the study’s findings and conclusions.
Privacy and Confidentiality

24. Every precaution must be taken to protect the privacy of research subjects and the confidentiality
of their personal information.

Informed Consent

25. Participation by individuals capable of giving informed consent as subjects in medical research
must be voluntary. Although it may be appropriate to consult family members or community leaders, no
individual capable of giving informed consent may be enrolled in a research study unless he or she freely
agrees.

26. In medical research involving human subjects capable of giving informed consent, each potential
subject must be adequately informed of the aims, methods, sources of funding, any possible conflicts of
interest, institutional affiliations of the researcher, the anticipated benefits and potential risks of the
study and the discomfort it may entail, post-study provisions and any other relevant aspects of the
study. The potential subject must be informed of the right to refuse to participate in the study or to
withdraw consent to participate at any time without reprisal. Special attention should be given to the
specific information needs of individual potential subjects as well as to the methods used to deliver the
information. After ensuring that the potential subject has understood the information, the physician or
another appropriately qualified individual must then seek the potential subject’s freely-given informed
consent, preferably in writing. If the consent cannot be expressed in writing, the non-written consent
must be formally documented and witnessed. All medical research subjects should be given the option
of being informed about the general outcome and results of the study.

27. When seeking informed consent for participation in a research study the physician must be
particularly cautious if the potential subject is in a dependent relationship with the physician or may
consent under duress. In such situations the informed consent must be sought by an appropriately
qualified individual who is completely independent of this relationship.

28. For a potential research subject who is incapable of giving informed consent, the physician must
seek informed consent from the legally authorised representative. These individuals must not be
included in a research study that has no likelihood of benefit for them unless it is intended to promote
the health of the group represented by the potential subject, the research cannot instead be performed
with persons capable of providing informed consent, and the research entails only minimal risk and
minimal burden.

29. When a potential research subject who is deemed incapable of giving informed consent is able to
give assent to decisions about participation in research, the physician must seek that assent in addition
to the consent of the legally authorised representative. The potential subject’s dissent should be
respected.
30. Research involving subjects who are physically or mentally incapable of giving consent, for
example, unconscious patients, may be done only if the physical or mental condition that prevents
giving informed consent is a necessary characteristic of the research group. In such circumstances the
physician must seek informed consent from the legally authorised representative. If no such
representative is available and if the research cannot be delayed, the study may proceed without
informed consent provided that the specific reasons for involving subjects with a condition that renders
them unable to give informed consent have been stated in the research protocol and the study has been
approved by a research ethics committee. Consent to remain in the research must be obtained as soon
as possible from the subject or a legally authorised representative.

31. The physician must fully inform the patient which aspects of their care are related to the
research. The refusal of a patient to participate in a study or the patient’s decision to withdraw from the
study must never adversely affect the patient-physician relationship.

32. For medical research using identifiable human material or data, such as research on material or
data contained in biobanks or similar repositories, physicians must seek informed consent for its
collection, storage and/or reuse. There may be exceptional situations where consent would be
impossible or impracticable to obtain for such research. In such situations the research may be done
only after consideration and approval of a research ethics committee.

Use of Placebo

33. The benefits, risks, burdens and effectiveness of a new intervention must be tested against those
of the best proven intervention(s), except in the following circumstances: Where no proven intervention
exists, the use of placebo, or no intervention, is acceptable; or Where for compelling and scientifically
sound methodological reasons the use of any intervention less effective than the best proven one, the
use of placebo, or no intervention is necessary to determine the efficacy or safety of an intervention and
the patients who receive any intervention less effective than the best proven one, placebo, or no
intervention will not be subject to additional risks of serious or irreversible harm as a result of not
receiving the best proven intervention. Extreme care must be taken to avoid abuse of this option.

Post-Trial Provisions

34. In advance of a clinical trial, sponsors, researchers and host country governments should make
provisions for post-trial access for all participants who still need an intervention identified as beneficial
in the trial. This information must also be disclosed to participants during the informed consent process.

Research Registration and Publication and Dissemination of Results

35. Every research study involving human subjects must be registered in a publicly accessible
database before recruitment of the first subject.
36. Researchers, authors, sponsors, editors and publishers all have ethical obligations with regard to
the publication and dissemination of the results of research. Researchers have a duty to make publicly
available the results of their research on human subjects and are accountable for the completeness and
accuracy of their reports. All parties should adhere to accepted guidelines for ethical reporting. Negative
and inconclusive as well as positive results must be published or otherwise made publicly available.
Sources of funding, institutional affiliations and conflicts of interest must be declared in the publication.
Reports of research not in accordance with the principles of this Declaration should not be accepted for
publication.

Unproven Interventions in Clinical Practice

37. In the treatment of an individual patient, where proven interventions do not exist or other known
interventions have been ineffective, the physician, after seeking expert advice, with informed consent
from the patient or a legally authorised representative, may use an unproven intervention if in the
physician’s judgement it offers hope of saving life, re-establishing health or alleviating suffering. This
intervention should subsequently be made the object of research, designed to evaluate its safety and
efficacy. In all cases, new information must be recorded and, where appropriate, made publicly
available.