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The Irrelevance of Equipoise 

Author: Robert M. Veatch a
Affiliation:   a Kennedy Institute of Ethics, Georgetown University, Washington, DC, USA
DOI: 10.1080/03605310701255776
Publication Frequency: 6 issues per year
Published in: journal Journal of Medicine and Philosophy, Volume 32, Issue 2 March 2007 , pages 167 - 183
Formats available: HTML (English) : PDF (English)
You have: FREE ACCESS FREE ACCESS

The circumstances under which this title is published have changed:

Reason for change: Changed Publisher
Now published by: Oxford University Press
Date of change: 2008



Abstract

It is commonly believed in research ethics that some form of equipoise is a necessary condition for justifying randomized clinical trials, that without it clinicians are violating the moral duty to do what is best for the patient. Recent criticisms have shown how complex the concept of equipoise is, but often retain the commitment to some form of equipoise for randomization to be justified. This article rejects that claim. It first asks for what one should be equally poised (scientific or clinical equipoise), then asks who should be equally poised (scientist, clinician, or subject), and finally asks why any of these players need be equally poised between treatment options. The article argues that only the subject's evaluation of the options is morally relevant and that even the subject need not be equally poised or indifferent between the options in order to volunteer for randomization. All that is needed is adequately informed, free, and unexploited consent. It concludes equipoise is irrelevant.
Keywords: consent to randomization; equipoise; idiosyncratic preferences; individual versus clinical equipoise
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