Gifford Fred
Department of Philosophy, Michigan State University, East Lansing, Michigan 48824, USA.
J Med Philos. 2007 Mar-Apr;32(2):135-50. doi: 10.1080/03605310701255743.
In this article, I review and expand upon arguments showing that Freedman's so-called "clinical equipoise" criterion cannot serve as an appropriate guide and justification for the moral legitimacy of carrying out randomized clinical trials. At the same time, I try to explain why this approach has been given so much credence despite compelling arguments against it, including the fact that Freedman's original discussion framed the issues in a misleading way, making certain things invisible: Clinical equipoise is conflated with community equipoise, and several versions of each are also conflated. But a misleading impression is given that, rather than distinct criteria being arbitrarily conflated, a puzzle is solved and a number of features unified. Various issues are pushed under the rug, hiding flaws of the "clinical equipoise" approach and thus deceiving us into thinking that we have a solution when we do not. Particularly significant is the ignoring of the crucial distinction between the individual patient decision and the policy decision.
在本文中，我回顾并扩展了一些观点，这些观点表明，弗里德曼所谓的“临床 equipoise”标准不能作为开展随机临床试验道德合法性的适当指导和正当理由。同时，我试图解释为什么尽管存在有力的反对论据，这种方法仍被给予了如此多的信任，包括弗里德曼最初的讨论以一种误导性的方式构建问题，使某些事情变得不可见这一事实：临床 equipoise 与社区 equipoise 被混为一谈，而且每种的几个版本也被混为一谈。但给人的误导性印象是，并非不同的标准被任意混淆，而是一个谜题得到了解决，一些特征被统一了。各种问题被掩盖起来，隐藏了“临床 equipoise”方法的缺陷，从而欺骗我们认为我们有了一个解决方案，而实际上我们并没有。特别重要的是忽略了个体患者决策和政策决策之间的关键区别。
