David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
Learn more about PhilPapers
Journal of Medical Ethics 32 (9):548-553 (2006)
Randomised controlled trials (RCTs) sometimes recruit participants who are desperate to receive the experimental treatment. This paper defends the practice against three arguements that suggest it is unethical first, desperate volunteers are not in equipoise. Second clinicians, entering patients onto trials are disavowing their therapeutic obligation to deliver the best treatment; they are following trial protocols rather than delivering individualised care. Research is not treatment; its ethical justification is different. Consent is crucial. Third, desperate volunteers do not give proper consent: effectively, they are coerced. This paper responds by advocating a notion of equipoise based on expert knowledge and widely shared values. Where such collective, expert equipoise exists there is a prima facie case for an RCT. Next the paper argues that trial entry does not involve clinicians disavowing their therapeutic obligation; individualised care based on insufficient evidence is not in patients best interest. Finally, it argues that where equipoise exists it is acceptable to limit access to experimental agents; desperate volunteers are not coerced because their desperation does not translate into a right to receive what they desire.
|Keywords||No keywords specified (fix it)|
|Categories||categorize this paper)|
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
|Through your library|
References found in this work BETA
No references found.
Citations of this work BETA
No citations found.
Similar books and articles
N. Waller Bruce (1995). Individual Autonomy and the Double-Blind Controlled Experiment: The Case of Desperate Volunteers. Journal of Medicine and Philosophy 20 (1).
Stephen Wear (1995). A Desperate Solution: Individual Autonomy and the Double-Blind Controlled Experiment. Journal of Medicine and Philosophy 20 (1):57-64.
Franklin G. Miller & Howard Brody (2002). What Makes Placebo-Controlled Trials Unethical? American Journal of Bioethics 2 (2):3 – 9.
P. Allmark (2001). Is It in a Neonate's Best Interest to Enter a Randomised Controlled Trial? Journal of Medical Ethics 27 (2):110-113.
David J. Torgerson & Carole J. Torgerson (2003). Avoiding Bias in Randomised Controlled Trials in Educational Research. British Journal of Educational Studies 51 (1):36 - 45.
Franklin G. Miller & Howard Brody (2007). Clinical Equipoise and the Incoherence of Research Ethics. Journal of Medicine and Philosophy 32 (2):151 – 165.
H. C. M. L. Rodrigues & P. P. van den Berg (2012). Randomized Controlled Trials of Maternal-Fetal Surgery: A Challenge to Clinical Equipoise. Bioethics.
B. P. Minogue, G. Palmer-Fernandez, L. Udell & B. N. Waller (1995). Individual Autonomy and the Double-Blind Controlled Experiment: The Case of Desperate Volunteers. Journal of Medicine and Philosophy 20 (1):43-55.
Carole J. Torgerson & David J. Torgerson (2001). The Need for Randomised Controlled Trials in Educational Research. British Journal of Educational Studies 49 (3):316 - 328.
P. Allmark (2006). Improving the Quality of Consent to Randomised Controlled Trials by Using Continuous Consent and Clinician Training in the Consent Process. Journal of Medical Ethics 32 (8):439-443.
Gordon C. S. Smith & Jill P. Pell (2003). Parachute Use to Prevent Death and Major Trauma Related to Gravitational Challenge: Systematic Review of Randomised Controlled Trials. Bmj 327 (7429):1459--61.
Lisa R. Stines & Norah C. Feeny (2008). Unique Ethical Concerns in Clinical Trials Comparing Psychosocial and Psychopharmalogical Interventions. Ethics and Behavior 18 (2 & 3):234 – 246.
Sven Ove Hansson (2006). Uncertainty and the Ethics of Clinical Trials. Theoretical Medicine and Bioethics 27 (2):149-167.
Nancy Cartwright (2010). What Are Randomised Controlled Trials Good For? Philosophical Studies 147 (1):59 - 70.
Added to index2010-08-24
Total downloads11 ( #131,222 of 1,096,601 )
Recent downloads (6 months)6 ( #37,677 of 1,096,601 )
How can I increase my downloads?