In a study of a new surgical technique with reduced complications, a surgeon excluded a case of intraoperative bleeding to improve the reported outcomes. Which ethical principle was violated: beneficence, research justice, or non‑maleficence?

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Research Integrity Violation: Scientific Validity

The surgeon violated the ethical principle of scientific validity and research integrity by selectively excluding unfavorable data, which fundamentally undermines the research's ability to advance knowledge and directly contradicts the requirement that research must be scientifically rigorous and provide reliable results.

Core Ethical Framework Violated

The surgeon's action of removing the bleeding complication case represents a fundamental breach of research ethics that intersects multiple principles:

Scientific Validity as an Ethical Imperative

  • Research must be scientifically rigorous and provide reliable results to have social value and advance knowledge 1
  • Ethics and science are intertwined such that poorly designed and conducted studies are unethical because they do not yield results that achieve social value by advancing knowledge or improving health 1
  • The ethical integrity of research must be ensured at all steps of the process, including data management and analysis, and interpretation and dissemination of results 1

Why This Violates Research Justice

While the question offers "Research Justice" as an option, the more precise violation is against scientific validity, which is itself an ethical requirement. However, this action does impact justice:

  • Fair participant selection requires that all populations have equal access to the potential benefits and risks of research 1
  • By excluding the complication case, the surgeon misrepresents the true risk profile, denying future patients accurate information about the procedure's actual safety
  • This creates an inequitable distribution of risk because future patients cannot make truly informed decisions based on falsified data 1

Why Not Beneficence or Non-Maleficence?

Beneficence and Non-Maleficence Apply to Patient Care

  • Beneficence requires acting in the best interest of the patient and maximizing possible benefits 1
  • Non-maleficence requires avoiding harm and minimizing risks to participants 1
  • These principles primarily govern the direct care relationship and treatment decisions, not data manipulation after the fact 1

The Primary Violation is Data Integrity

  • The bleeding occurred during surgery—the immediate clinical management would fall under beneficence/non-maleficence
  • The ethical violation occurred when the surgeon manipulated the research data by excluding this case from the report
  • This is fundamentally about honest reporting and scientific integrity, not about the care provided during the complication 1

Clinical and Research Implications

Impact on Future Patients

  • Falsified research results prevent the medical community from making evidence-based decisions about the procedure's true safety profile 1
  • Future patients cannot provide truly informed consent if the complication rate is misrepresented
  • This violates the principle that research must improve health or advance knowledge 1

Professional Responsibility

  • Transparent and honest disclosure is essential in research reporting, just as it is in clinical care 1
  • Researchers must maintain ethical integrity throughout the entire research process, including data analysis and dissemination 1

Answer to the Multiple Choice Question

The most accurate answer is that the surgeon violated scientific validity/research integrity, which is a fundamental ethical requirement for clinical research. If forced to choose among the three options provided (Beneficence, Research Justice, Non-maleficence), Research Justice is the closest match because the manipulation creates an inequitable distribution of accurate risk information to future patients and the medical community 1.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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