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Fred Gifford, Freedman's ‘Clinical Equipoise’ and ‘Sliding-Scale All-Dimensions-Considered Equipoise’, The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, Volume 25, Issue 4, 2000, Pages 399–426, https://doi.org/10.1076/0360-5310(200008)25:4;1-A;FT399
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Abstract
It is often claimed that a clinical investigator may ethically participate (e.g., enroll patients) in a trial only if she is in equipoise (if she has no way to ground a preference for one arm of the study). But this is a serious problem, for as data accumulate, it can be expected that there will be a discernible trend favoring one of the treatments prior to the point where we achieve the trial's objective.
In this paper, I critically evaluate Benjamin Freedman's ‘clinical equipoise’ solution to this dilemma. I argue that Freedman actually puts forth at least two distinct contrasts – one in terms of community vs. individual equipoise, and another concerning clinical vs. theoretical equipoise – and that neither of them resolves the dilemma. I then make a proposal for a more adequate account of how to think about the circumstances under which entering subjects in trials would be justified – a ‘sliding-scale equipoise’ that arises out of a discussion of patients' values.
