Gifford Fred
Michigan State University, East Lansing, USA.
Kennedy Inst Ethics J. 2007 Sep;17(3):203-26; discussion 227-46. doi: 10.1353/ken.2007.0020.
As clinicians, researchers, bioethicists, and members of society, we face a number of moral dilemmas concerning randomized clinical trials. How we manage the starting and stopping of such trials--how we conceptualize what evidence is sufficient for these decisions--has implications for both our obligations to trial participants and for the nature and security of the resultant medical knowledge. One view of how this is to be done, "clinical equipoise," recently has been given an extended defense by Paul Miller and Charles Weijer in their article "Rehabilitating Equipoise." The present paper critiques this position and Miller and Weijer's defense of it. I argue that their attempted rehabilitation fails. Their analysis suffers from a number of confusions, as well as a failure to make crucial distinctions, adequately to clarify key concepts, or to think through exactly what needs to be established to justify their claim. We are left with little reason to uphold the clinical equipoise criterion.
作为临床医生、研究人员、生物伦理学家以及社会成员，我们面临着一些与随机临床试验相关的道德困境。我们如何管理此类试验的启动和停止——我们如何界定足以支持这些决策的证据——这既关乎我们对试验参与者的义务，也关乎由此产生的医学知识的性质和安全性。关于如何做到这一点的一种观点，即“临床 equipoise”，最近在保罗·米勒（Paul Miller）和查尔斯·韦杰尔（Charles Weijer）的文章《恢复 equipoise》中得到了进一步的辩护。本文对这一立场以及米勒和韦杰尔对它的辩护进行了批判。我认为他们试图恢复的努力失败了。他们的分析存在诸多混淆之处，同时未能做出关键区分、充分阐明关键概念，或者深入思考为证明其主张需要确立什么。我们几乎没有理由坚持临床 equipoise 标准。
