A Normative Justification for Distinguishing the Ethics of Clinical Research from the Ethics of Medical Care

Author:

Litton Paul,Miller Franklin G.

Abstract

In the research ethics literature, there is strong disagreement about the ethical acceptability of placebo-controlled trials, particularly when a tested therapy aims to alleviate a condition for which standard treatment exists. Recently, this disagreement has given rise to debate over the moral appropriateness of the principle of clinical equipoise for medical research. Underlying these debates are two fundamentally different visions of the moral obligations that investigators owe their subjects.Some commentators and ethics documents claim that physicians, whether acting as care givers or researchers, have the same duty of beneficence towards their patients and subjects: namely, that they must provide optimal medical care. In discussing placebo surgery in research on refractory Parkinson's disease, Peter Clark succinctly states this view: “The researcher has an ethical responsibility to act in the best interest of subjects.”

Publisher

Cambridge University Press (CUP)

Subject

Health Policy,General Medicine,Issues, ethics and legal aspects

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4. 29 So, for example, Rousseau argues that a choice to become a slave should not be respected precisely because it is irrational or unacceptably foolish: Now, since, in the relations between men, the worst that can happen to someone is for him to see himself at the discretion of someone else, would it not have been contrary to good sense to begin by surrendering into the hands of a leader the only things for whose preservation they needed his help? What equivalent could he have offered them for the concession of so fine a right?. Rousseau J. J., “Discourse on the Origin of Inequality,” in Cress D. A., trans., Basic Political Writings (Indianapolis: Hackett Publishing, 1987): At 72. Steinberg, in fact, makes this argument, stating that “no rational person would sign” a consent form that informed a potential subject that the ethics governing the protocol deviated from the ethics of medical care. Steinberg, supra note 6, at 27.

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