Resituating the principle of equipoise: justice and access to care in non-ideal conditions.
The principle of equipoise traditionally is grounded in the special obligations of physician-investigators to provide research participants with optimal care. This grounding makes the principle hard to apply in contexts with limited health resources, to research that is not directed by physicians, or to nontherapeutic research. I propose a different version of the principle of equipoise that does not depend upon an appeal to the Hippocratic duties of physicians and that is designed to be applicable within a wider range of research contexts and types, including health services research and research on social interventions. I consider three examples of ethically contentious research trials conducted in three different social settings. I argue that in each case my version of the principle of equipoise provides more plausible and helpful guidance than does the traditional version of the principle.
Kukla
Rebecca
R
University of South Florida, Tampa, USA.
D019380:Anti-HIV Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D018849:Controlled Clinical Trials as Topic / Q000941:ethics*; D003695:Delivery of Health Care / Q000941:ethics* / Q000592:standards; D003906:Developing Countries; D004493:Education / Q000941:ethics / Q000592:standards; D026689:Ethical Analysis; D028663:Ethical Theory; D032984:Ethics, Research; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy; D006297:Health Services Accessibility / Q000941:ethics*; D006801:Humans; D007223:Infant; D008131:London; D008297:Male; D028681:Moral Obligations; D018673:Nutrition Policy; D026684:Personal Autonomy; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D012107:Research Design; D012108:Research Personnel / Q000941:ethics*; D012935:Social Justice / Q000941:ethics; D036302:Therapeutic Human Experimentation / Q000941:ethics; D035501:Uncertainty; D014481:United States; D015215:Zidovudine / Q000008:administration & dosage
D019380:Anti-HIV Agents; D015215:Zidovudine