Abstract
In their article, MacKay and Saylor analyze the issue of fair subject selection in clinical research and suggest that this overarching principle is best understood as a collection of four sub-principles, namely fair inclusion, fair opportunity, fair burden sharing, and fair distribution of third-party risks. After describing these principles, the authors suggest several strategies for managing potential tensions between these four sub-imperatives, as conflicts are likely in practice. The authors’ strategies for negotiating the multiple ethical perspectives highlighted by these sub-imperatives are crucial because they support a robust concept of fairness that acknowledges the need to protect research volunteers without denying them access to potentially beneficial research. In this regard, the analysis offered by MacKay and Saylor provides a useful way of revealing several salient ethical considerations that are relevant to a claim to scarce healthcare resources.