Declaration of Helsinki 2008

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THE WORLD MEDICAL ASSOCIATION, INC.
DECLARATION OF HELSINKI
Ethical Principles for Medical Research Involving Human Subjects
Adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, and amended by the:
29th WMA General Assembly, Tokyo, Japan, October 1975
35th WMA General Assembly, Venice, Italy, October 1983
41st WMA General Assembly, Hong Kong, September 1989
48th WMA General Assembly, Somerset West, Republic of South Africa, October 1996
52nd WMA General Assembly, Edinburgh, Scotland, October 2000
53th WMA General Assembly, Washington, United States, October 2002
(Note of Clarification on paragraph 29 added)
55th WMA General Assembly, Tokyo, Japan, October 2004
(Note of Clarification on Paragraph 30 added)
WMA General Assembly, Seoul, Korea, October 2008
A. INTRODUCTION
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 not be applied without consideration of all other relevant paragraphs.
2. Although the Declaration is addressed primarily to physicians, the WMA encourages
other participants in medical research involving human subjects to adopt these
principles.
3. It is the duty of the physician to promote and safeguard the health of patients, including
those who are involved in medical research. The physician’s knowledge and conscience
are dedicated to the fulfilment of this duty.
4. 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.”
5. Medical progress is based on research that ultimately must include studies involving
human subjects. Populations that are underrepresented in medical research should be
provided appropriate access to participation in research.
6. In medical research involving human subjects, the well-being of the individual research
subject must take precedence over all other interests.
7. 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 current
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interventions must be evaluated continually through research for their safety,
effectiveness, efficiency, accessibility and quality.
8. In medical practice and in medical research, most interventions involve risks and
burdens.
9. Medical research is subject to ethical standards that promote respect for all human
subjects and protect their health and rights. Some research populations are particularly
vulnerable and need special protection. These include those who cannot give or refuse
consent for themselves and those who may be vulnerable to coercion or undue
influence.
10. Physicians should 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.
B. PRINCIPLES FOR ALL MEDICAL RESEARCH
11. It is the duty of physicians who participate in medical research to protect the life, health,
dignity, integrity, right to self-determination, privacy, and confidentiality of personal
information of research subjects.
12. 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.
13. Appropriate caution must be exercised in the conduct of medical research that may
harm the environment.
14. The design and performance of each research study involving human subjects must be
clearly described 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, other potential conflicts of interest,
incentives for subjects and provisions for treating and/or compensating subjects who are
harmed as a consequence of participation in the research study. The protocol should
describe arrangements for post-study access by study subjects to interventions identified
as beneficial in the study or access to other appropriate care or benefits.
15. The research protocol must be submitted for consideration, comment, guidance and
approval to a research ethics committee before the study begins. This committee must
be independent of the researcher, the sponsor and any other undue influence. 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
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ongoing studies. The researcher must provide monitoring information to the committee,
especially information about any serious adverse events. No change to the protocol may
be made without consideration and approval by the committee.
16. Medical research involving human subjects must be conducted only by individuals with
the appropriate scientific training and qualifications. Research on patients or healthy
volunteers requires the supervision of a competent and appropriately qualified physician
or other health care professional. The responsibility for the protection of research
subjects must always rest with the physician or other health care professional and never
the research subjects, even though they have given consent.
17. Medical research involving a disadvantaged or vulnerable population or community is
only justified if the research is responsive to the health needs and priorities of this
population or community and if there is a reasonable likelihood that this population or
community stands to benefit from the results of the research.
18. Every medical research study involving human subjects must be preceded by careful
assessment of predictable risks and burdens to the individuals and communities
involved in the research in comparison with foreseeable benefits to them and to other
individuals or communities affected by the condition under investigation.
19. Every clinical trial must be registered in a publicly accessible database before
recruitment of the first subject.
20. Physicians may not participate in a research study involving human subjects unless they
are confident that the risks involved have been adequately assessed and can be
satisfactorily managed. Physicians must immediately stop a study when the risks are
found to outweigh the potential benefits or when there is conclusive proof of positive
and beneficial results.
21. Medical research involving human subjects may only be conducted if the importance of
the objective outweighs the inherent risks and burdens to the research subjects.
22. Participation by competent individuals as subjects in medical research must be
voluntary. Although it may be appropriate to consult family members or community
leaders, no competent individual may be enrolled in a research study unless he or she
freely agrees.
23. Every precaution must be taken to protect the privacy of research subjects and the
confidentiality of their personal information and to minimize the impact of the study on
their physical, mental and social integrity.
24. In medical research involving competent human subjects, 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, 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
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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.
25. For medical research using identifiable human material or data, physicians must
normally seek consent for the collection, analysis, storage and/or reuse. There may be
situations where consent would be impossible or impractical to obtain for such research
or would pose a threat to the validity of the research. In such situations the research may
be done only after consideration and approval of a research ethics committee.
26. When seeking informed consent for participation in a research study the physician
should 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
should be sought by an appropriately qualified individual who is completely
independent of this relationship.
27. For a potential research subject who is incompetent, the physician must seek informed
consent from the legally authorized 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 population represented by the potential subject,
the research cannot instead be performed with competent persons, and the research
entails only minimal risk and minimal burden.
28. When a potential research subject who is deemed incompetent 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 authorized representative. The potential subject’s dissent
should be respected.
29. 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 population. In such circumstances the physician should seek informed consent
from the legally authorized 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 should be obtained as soon as possible from the subject or a legally authorized
representative.
30. Authors, editors and publishers all have ethical obligations with regard to the
publication of the results of research. Authors 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. They should adhere to accepted guidelines for ethical
reporting. Negative and inconclusive as well as positive results should be published or
otherwise made publicly available. Sources of funding, institutional affiliations and
conflicts of interest should be declared in the publication. Reports of research not in
accordance with the principles of this Declaration should not be accepted for
publication.
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C. ADDITIONAL PRINCIPLES FOR MEDICAL RESEARCH COMBINED WITH
MEDICAL CARE
31. The physician may combine medical research with medical care only to the extent that
the research 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.
32. The benefits, risks, burdens and effectiveness of a new intervention must be tested
against those of the best current proven intervention, except in the following
circumstances:
• The use of placebo, or no treatment, is acceptable in studies where no current
proven intervention exists; or
• Where for compelling and scientifically sound methodological reasons the use of
placebo is necessary to determine the efficacy or safety of an intervention and the
patients who receive placebo or no treatment will not be subject to any risk of
serious or irreversible harm. Extreme care must be taken to avoid abuse of this
option.
33. At the conclusion of the study, patients entered into the study are entitled to be
informed about the outcome of the study and to share any benefits that result from it, for
example, access to interventions identified as beneficial in the study or to other
appropriate care or benefits.
34. The physician must fully inform the patient which aspects of the 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 interfere with the patient-physician relationship.
35. In the treatment of a patient, where proven interventions do not exist or have been
ineffective, the physician, after seeking expert advice, with informed consent from the
patient or a legally authorized representative, may use an unproven intervention if in the
physician’s judgement it offers hope of saving life, re-establishing health or alleviating
suffering. Where possible, this intervention should be made the object of research,
designed to evaluate its safety and efficacy. In all cases, new information should be
recorded and, where appropriate, made publicly available.
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