The physician as caregiver and researcher.

The physician might happen to play a double role in the clinical setting when he is the caregiver as well as the researcher for a patient at the same time. The dynamics and the ethical profile of the two relationships caregiver-patient and researcher-subject are different, and conflicts might arise: while the main responsibility of the caregiver is directed towards the patient "here and now", the researcher has a primary responsibility for future patients, the scientific community and the society at large. It has been suggested that in the clinical setting the researcher, provided that all the requirements for the ethical conduct of an experimentation be respected, has an "autonomy-in-trust", i.e. a wide discretional space in the decision-making process. While agreeing with such a proposal to some extent, we suggest that a more active and deeper participation of subjects in the experimental process, through an ongoing consent and joint decision-making process, would help in overcoming many possible conflicts.