J Clin Ethics. 2024 Spring;35(1):8-22. doi: 10.1086/728144.
AbstractThere is societal consensus that cancer clinical trial participation is unjust because some sociodemographic groups have been systematically underrepresented. Despite this, neither a definition nor an ethical explication for the justice norm of equity has been clearly articulated in this setting, leading to confusion over its application and goals. Herein we define equity as acknowledging sociodemographic circumstances and apportioning resource and opportunity allocation to eliminate disparities in outcomes, and we explore the issues and tensions this norm generates through practical examples. We assess how equality-based enrollment structures in clinical cancer research have perpetuated historical disparities and what equity-based alternatives are necessary to achieve representativeness and an expansive conception of participatory justice in clinical cancer research. This framework addresses the breadth from normative to applied by defining the justice norm of equity and translating it into practical strategies for addressing participation disparities in clinical cancer research.
社会共识认为，癌症临床试验的参与是不公正的，因为一些社会人口群体的参与一直受到系统的排斥。尽管如此，在这种情况下，公平作为正义规范既没有被明确定义，也没有得到伦理上的阐述，导致其应用和目标存在混淆。在这里，我们将公平定义为承认社会人口状况，并分配资源和机会分配，以消除结果上的差异，我们通过实际例子探讨这一规范产生的问题和紧张关系。我们评估了临床癌症研究中基于平等的入组结构如何延续了历史上的差异，以及为了实现代表性和更广泛的临床癌症研究参与的正义观念，需要什么样的基于公平的替代方案。这一框架从规范性到应用性都进行了定义，定义了公平的正义规范，并将其转化为解决临床癌症研究参与差异的实际策略。
