Historically, clinical medical research and clinical medical care were viewed as similar and as intertwined. In 1979, however, the Belmont Report disentangled research and care, defining clear boundaries between the two. Central to the distinction was the idea that the purpose of clinical research is fundamentally different from that of clinical medicine: whereas medical care focuses on providing optimal care to individual patients, clinical research is primarily concerned with producing generalizable knowledge for the benefit of future patients.

Thirty years after Belmont, the sharp distinction between research and care is becoming increasingly blurred. Medical care and clinical research are extensively, deliberately, and routinely integrated in numerous settings.

In what follows, we imagine a plausible setting in which research and care are integrated in ways that build on and transcend existing practices. This thought experiment is not intended to outline a model of research-care integration that would be readily accepted in the marketplace; rather, the thought experiment allows us to explore why research-care integration is ethically plausible and to explore the ethical questions that arise in such a maximally integrated environment. Our objective is twofold: to show that the ongoing integration of research and care is both justified and desirable and to illustrate that systematic integration requires the rethinking of concepts, tools, and regulations familiar to clinical medical and research ethicists.