Equipoise, or the criterion of honest professional uncertainty in the clinical community, is currently the most widely accepted standard for adjudicating the ethical dilemmas of medical research involving human patients. Nonetheless, equipoise has recently become a subject of considerable criticism. Among the objections to equipoise, an important one is based on the observation of an objective difficulty for equipoise in providing sound ethical guidance in practical circumstances that arise in clinical research. A chief example of such problem is represented by (...) the case of monitoring accumulating data from a trial. In this article we argue that the perceived inadequacy of equipoise in this context is caused by a widespread misconception of the relation between equipoise and more fundamental ethical principles. We argue that, when interpreted as a mid-level principle, the value of equipoise as the appropriate ethical guidance for clinical research becomes more firmly established. (shrink)

Clinical equipoise links ethically appropriate medical research with medical research that has the reasonable chance of resolving debates. We argue against this principle on the ground that most debates in medicine cannot be resolved by the outcomes of any particular empirical study. In fact, a deep understanding of the methodology of scientific research leads to the conclusion that adopting clinical equipoise as an ethical standard for medical research would deprive medical researchers of the ability to confirm clinical hypotheses.

The concept of equipoise is considered by many to be part of the ethical justification for using human subjects in clinical research. In general, equipoise indicates some uncertainty about the relative merits of the experimental intervention compared to existing treatments. Relieving this uncertainty gives scientific value to an experiment, thereby making the risks to human subjects in the trial acceptable, other considerations notwithstanding. But characterizing equipoise remains controversial since Freedman’s groundbreaking publication on the subject. We offer a new account of (...) equipoise that draws on and extends an option Freedman discarded. After establishing the importance of some account of equipoise as part of ethically justified clinical trials, we revisit Freedman’s distinction between clinical and theoretical equipoise. We raise concerns about Freedman’s preferred clinical equipoise and then rehabilitate theoretical equipoise. In particular, we use a variety of arguments from epistemology to show how Freedman was too hasty in rejecting theoretical equipoise. In addition, we argue that theoretical equipoise is a subspecies of epistemic equipoise, which we characterize as a form of uncertainty that is the result of the possibility of error. This type of uncertainty can best be alleviated by research, which produces beliefs supported by strong statistical evidence, which is a key aim of clinical trials. Further, this type of uncertainty can explain why even clinicians with more firsthand experience with an intervention than their peers, and who may not be in theoretical equipoise, could still justifiably support a trial designed to ameliorate the possibility of error due to cognitive bias. (shrink)

This article questions the commonly held view that professional ethics is grounded in general ethical principles, in particular, respect for client (or patient) autonomy and beneficence in the treatment of clients (or patients). Although these are admirable as general ethical principles, we argue that there is considerable logical difficulty in applying them to the professional-client relationship. The transition from general principles to professional ethics cannot be made because the intended conclusion applies differently to each of the parties involved, whereas the (...) premise is a general principle that applies equally to both parties. It is widely accepted that professionals are required to recognize that clients or patients possess rights to autonomy that are more than the general rights to personal autonomy accepted in ordinary social life, and that professionals are expected to display beneficence toward their clients that is more than the beneficence expected of anyone in ordinary social life. The comparative component of professional ethics is an intrinsic feature of the professional situation, and thus it cannot be bypassed in working out a proper professional ethics. Thus, we contend, the proper professional treatment of clients or patients has not been explained by appeal to general ethical principles. (shrink)

Those with Anton’s syndrome believe they can see things around them even though they are completely blind. Patients with this and other syndromes confabulate in predictable circumstances: they believe and assert obvious falsehoods. I argue in this article that absent competing obligations, provoking such confabulations for non-medical purposes is problematic. I further argue that these confabulations share all relevant properties with a particular kind of everyday confabulation. Flashbulb memories—memories of surprising, monumental, emotionally laden events—are also believed, obvious falsehoods that occur (...) in predictable circumstances. Hence, provoking such confabulations is also problematic, absent competing obligations. This leads to a counterintuitive conclusion: absent competing obligations, those who understand flashbulb memories ought to avoid asking people about their memories of experiences of flashbulb events such as the Challenger explosion or September 11, 2001. (shrink)