Research in the terminally ill and in conditions of emergency medicine, in these circumstances subjects are potentially very vulnerable as waiver from consent may be inevitable despite several social, legal and ethical debates. The conditions for waiver need to be characterized in the protocol in accord with concerned ERBs. Unlicensed interventions maybe dispensed with no alternative standard therapies being available, with inadequate clinical safety and efficacy data. Nevertheless, the requisites for subject consent/ LAR later in the study are to be implemented.
Considering the acuteness of the underlying clinical pathology, participants may reach the study endpoints early in the course of study based on protocol evaluation criteria, necessitating data reviewing committees to proffer early and frequent analyses with an obligation to provide cyclical efficacy, safety and risks versus benefits recommendations to stakeholders. Further in this form of research, befitting statistical designs and inferences are to be cogitated.
Research in hierarchical organizations as in the armed forces, institutions or hospital groups, here employees or students by nature of adjacency of work or association with investigators, may acquiesce to participate in anticipation of favoritism, consternation, retribution or compelling socioeconomic backgrounds. ERBs need to be extra cautious to make safe the environment with exigencies involved, to ensure participants be neither pressured nor persuaded. Declination to participate should not affect their careers and credits.