Commentary: No simple and absolute ethical rule exists for every conceivable situation

The obvious ethical problems posed by this study concern ( a ) the fact that all patients admitted to the intensive care unit over a six month period were included in the study without their knowledge or consent, and ( b ) the fact that blood samples obtained from all patients were tested for HIV infection without the consent of the patients, with the information that blood samples had been tested for the infection being given to patients only after the test had been done. At first sight the decision to override the patients' right to full information, and to give or to refuse consent to inclusion and testing, seemed to all members of the research ethics committee to be so fundamentally at variance with the ethical principles governing research involving patients that it seemed impossible to give ethical approval for the study. However, during lengthy discussions with the investigators several considerations emerged. Firstly, the information being sought by the investigators was clearly going to be of crucial importance to the community, not only in South Africa or in Africa as a whole but also worldwide. The importance of the study was perceived to be twofold. If it showed that a patient's HIV status significantly worsened his or her chances of a favourable outcome from intensive care–to …