So-called "clinical equipoise" and the argument from design.
In this article, I review and expand upon arguments showing that Freedman's so-called "clinical equipoise" criterion cannot serve as an appropriate guide and justification for the moral legitimacy of carrying out randomized clinical trials. At the same time, I try to explain why this approach has been given so much credence despite compelling arguments against it, including the fact that Freedman's original discussion framed the issues in a misleading way, making certain things invisible: Clinical equipoise is conflated with community equipoise, and several versions of each are also conflated. But a misleading impression is given that, rather than distinct criteria being arbitrarily conflated, a puzzle is solved and a number of features unified. Various issues are pushed under the rug, hiding flaws of the "clinical equipoise" approach and thus deceiving us into thinking that we have a solution when we do not. Particularly significant is the ignoring of the crucial distinction between the individual patient decision and the policy decision.
Gifford
Fred
F
Department of Philosophy, Michigan State University, East Lansing, Michigan 48824, USA. gifford@msu.edu
D032984:Ethics, Research; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000941:ethics*; D012935:Social Justice; D035501:Uncertainty