Fiduciary Obligations of the Physician Scientist in a Post Hippocratic Era

This dissertation analyzes the multiple layers of physician scientists’ obligations and argues for extending fiduciary liability to physicians conducting clinical research with human participants. Allegations of scientific dishonesty and fraud have cast a shadow on the integrity of medical researchers. Some physician scientists have succumbed to pressure to publish for professional renown, while others have been seduced by the temptation to yield greater pecuniary gains. As fiduciaries, physician scientists must avoid potential conflicts of interest. In industry-funded research, such conflicts arise when the physician scientist has a pecuniary interest in the sponsoring pharmaceutical company.;My analysis uses P. D. Finn’s reasonable expectation test. The actual circumstances justifying a reasonable expectation of physician scientists’ fiduciary loyalty would be the duty of beneficence, i.e. to act in the interests of the research patient, international legislation and judicial prescriptions on the duty of care in clinical research.;The analysis extends two important entitlements to research patients: The reasonable expectation that the physician scientist will act with the proper motive and non-speculation on the trustworthiness of the physician scientist’s motive. The analysis is influenced by Lionel Smith’s treatise on fiduciary obligation and scrutiny of motive: a fiduciary’s motive to act (or not act) is subject to judicial review because motive not harm determines fiduciary disloyalty.;The notion of fiduciary entitlements as a cohesive theory uniting deontological, consequentialist and rights-based approaches to physician scientist obligations will be considered as a basis for future study.;My examination begins by deconstructing fiduciary doctrine and identifying three theoretical models: the categorical approach, the underlying principles analysis, and the prophylaxis, motive and entitlement model. The fiduciary principles of trust and confidence, good faith, and loyalty form the normative construct for analysis of legal instruments and judicial prescriptions regarding clinical research standard of care. The overarching fiduciary principle of loyalty is determined to be commensurable with the physician’s duty of beneficence: the duty to act in the patient’s best interest.