title: Emergency Preservation and Resuscitation Trial: A Philosophical Justification for Non-Voluntary Enrollment.
abstract: In a current clinical trial for Emergency Preservation and Resuscitation (EPR), Dr. Samuel Tisherman of the University of Maryland aims to induce therapeutic hypothermia in order to 'buy time' for operating on victims of severe exsanguination. While recent publicity has framed this controversial procedure as 'killing a patient to save his life', the US Army and Acute Care Research appear to support the study on the grounds that such patients already face low chances of survival. Given that enrollment in the trial must be non-voluntary, the study has received an exemption from federal standards for obtaining informed consent. How exactly, if at all, is non-voluntary enrollment morally justifiable? In this essay, I appeal to the notable work of Hans Jonas in an effort to defend the EPR trial's use of non-voluntary enrollment. It is often thought and, as I show, it may appear that Jonas has called for the end of experimental medical practice. Still, I derive from Jonas a principle of double-effect upon which physicians may be seen as morally permitted to pursue innovations in emergency medicine but only as a byproduct of pursuing therapeutic success. With this position, I argue that the EPR trial can be granted a stronger philosophical justification than simply waiving the requirement of obtaining informed consent. The double-effect justification would obtain, perhaps regardless of the success of such innovative procedures as therapeutic hypothermia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tigard
mesh_terms: D050792:Circulatory Arrest, Deep Hypothermia Induced; D004992:Ethics, Medical; D058734:Exsanguination; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D028681:Moral Obligations; D012106:Research; D035842:Research Subjects; D012151:Resuscitation
keywords: Hans Jonas; critical care; double-effect; emergency preservation and resuscitation; informed consent; research ethics