• F Gifford.
• Department of Philosophy, Michigan State University, East Lansing, Michigan 48824-1032, USA. gifford@msu.edu
• J Med Philos. 2000 Aug 1; 25 (4): 399-426.

AbstractIt is often claimed that a clinical investigator may ethically participate (e.g., enroll patients) in a trial only if she is in equipoise (if she has no way to ground a preference for one arm of the study). But this is a serious problem, for as data accumulate, it can be expected that there will be a discernible trend favoring one of the treatments prior to the point where we achieve the trial's objective. In this paper, I critically evaluate Benjamin Freedman's 'clinical equipoise' solution to this dilemma. I argue that Freedman actually puts forth at least two distinct contrasts--one in terms of community vs. individual equipoise, and another concerning clinical vs. theoretical equipoise--and that neither of them resolves the dilemma. I then make a proposal for a more adequate account of how to think about the circumstances under which entering subjects in trials would be justified--a 'sliding-scale equipoise' that arises out of a discussion of patients' values.

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