Available via natural death a randomized lottery

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available via natural death, a randomized lottery selection of suitable living donorsshould beenacted; C) The selected donor would then be compelled to give up their life for the sakeofincreasing utility• Policy regulations would mitigate against the disutility of insecurity: 1) everyone hastheknowledge of the lottery, 2) no one would be discriminately selected"75: Clinical Research & Public Good• Freedman on EQUIPOISE: (i.e. balancing considerations, interests and informationwhendetermining a course of action or treatment)• Theoretical Equipoise: one must have a neutral stance towards the available options andonly decide for one or the other when the balance is tipped —> Freedman: ’conceptuallyoddand ethically irrelevant’ (462):1. Data enlisted to support competing hypotheses going into an experimental trials willdisrupt equipoise from the beginning2. Investigators will import their own biases into the perception and interpretation of data,artificially tipping the balance in favour of one arm of the experiment3. If one option of treatment seems inferior according to initial findings it would seemunethical to ask participants to undergo theoretically inferior treatments4. Exceedingly difficult for a clinical trial to theoretically satisfy ethical principles,makingpublication and use of findings potentially problematic• Clinical Equipoise: does not suffer from the same epistemic limitations because it‘dependson some combination of effectiveness, consistency, minimal or relievable side effects,and otherfactors’ (462)• Purpose of entering into clinical trials in the first place is to come to a reasoned andevidence-based resolution to a reasoned and evidence-based conflict over what treatmentoption is best for a certain patient population
• Clinical Equipoise Ethics:1. There exists a professional disagreement regarding merits of alternate treatmentoptions;so if there is no such disagreement, it would be unethical to engage in trials based ondiscredited or outlandish treatment options2. By undertaking a clinical trial, there is sufficient reason to expect this equipoise will bedisturbed, and when disturbed, de facto consensus among competent professionals will beachieved"83. It is ethical to allow patients to participate in such trials because the information giventopatients to ground informed consent will reveal the honest disagreement among theprofessional communityHellman on Clinical Equipoise and Physician-Patient Relationship:• The physician-patient relationship involves developing a specific understanding of theindividual, their symptoms, medical history, molecular markers, their values,psychologicalfactors, etc.• Clinical trials require grouping individual patients into an indifferent group where theybecome members whose treatment options are determined after randomized testingdeterminestheir median value within a statistical range and this has the potential to undermine the

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Term
Spring
Professor
StefanRodde
Tags
Ethics, Clinical trial, Informed consent

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