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The World Medical Association’s Declaration of Helsinki (DoH) defines the ethical principles for medical research involving human participants. A two-and-a-half-year critical review culminated in the adoption of a new version in October 2024. This article elucidates the revision process, describes the additions and other changes, highlights the elements that have remained consistent throughout this and previous revisions, and ends by considering potential objections to the revised version.Of several noteworthy changes, the most intensely debated was the issue of vulnerability. The new version recognises vulnerability as a potentially contextual and dynamic state, addressing the tension between ensuring the necessary protection for those in a situation of vulnerability, while also weighing the potential harm and injustice of excluding them from studies.The international workgroup tasked with revising the DoH also incorporated several aspects of the principle of justice, including explicit calls for consideration of structural inequities and for active inclusion of research participants (previously research subjects) and communities when planning research.Proposals to strengthen Research Ethics Committees (RECs) are described, and both sponsoring and host countries’ RECs must assess collaborative international projects. Research participants must be provided with any beneficial interventions demonstrated by the research in which they participated, and conversely, compensation must be provided to participants who suffer harm through their participation.Finally, while past versions of the DoH primarily addressed physicians, only ‘encouraging’ other professions and institutions involved in human research to consider its provisions, the 2024 version ‘holds that these principles should be upheld’ by others involved.