A desperate solution: individual autonomy and the double-blind controlled experiment.

The randomization ingredient in double-blind controlled experiments may be objectionable to patients who, in their desperation, come to such trials seeking a last chance of cure. Minogue et al., who view such a situation as inherently exploitive and undermining of patient autonomy, propose that such "desperate volunteers" instead be enrolled in the active arm, while other patients, less desperate and more committed to medical progress, continue to be randomized. Their view is critiqued as destructive of medical progress, inappropriate in its lack of clinical response to such patients, and fatally flawed by unrealistic notions of autonomy and voluntariness.