Toroyan T, Roberts I, Oakley A
Institute of Child Health, London.
J Med Ethics. 2000 Oct;26(5):319-22. doi: 10.1136/jme.26.5.319.
Equipoise is widely regarded to be an essential prerequisite for the ethical conduct of a randomised controlled trial. There are some circumstances however, under which it is acceptable to conduct a randomised controlled trial (RCT) in the absence of equipoise. Limited access to the preferred intervention is one such circumstance. In this paper we present an example of a randomised trial in which access to the preferred intervention, preschool education, was severely limited by resource constraints. The ethical issues that arise when conducting randomised trials in health care are considered in the context of trials of social interventions. In health, education and social welfare, effective interventions are frequently limited due to budgetary constraints. Explicit acknowledgement of the need to ration interventions, and the use of random allocation to do this even in the absence of equipoise, would facilitate learning more about the effects of these interventions.
均衡被广泛认为是随机对照试验合乎伦理进行的必要前提。然而，在某些情况下，在缺乏均衡的情况下进行随机对照试验也是可以接受的。获得首选干预措施的机会有限就是这样一种情况。在本文中，我们给出了一个随机试验的例子，在该试验中，获得首选干预措施（学前教育）的机会因资源限制而受到严重限制。在社会干预试验的背景下考虑了在医疗保健中进行随机试验时出现的伦理问题。在卫生、教育和社会福利领域，有效的干预措施常常由于预算限制而受到限制。明确承认有必要对干预措施进行分配，并即使在缺乏均衡的情况下也使用随机分配来做到这一点，将有助于更多地了解这些干预措施的效果。
