Pros And Cons Of Equipoise

Freedman disagrees with the view of equipoise because he believes that “Equipoise doesn’t not depend on uncertainty in the physician but on the genuine disagreement in the medical community about a treatment’s value because of a lack of good evidence gleaned from randomized clinical trials” (259). According to critics, equipoise is lost when a physician has a slight belief that one treatment is inferior to the other. Freedman disagrees and believes that equipoise is disrupted when there is a large disagreement between health care providers. If a physician has a slight doubt in a treatment, it’s not enough to stop the continuation of a patient’s participation in a clinical trial.

Freedman acknowledges the arguments of the Hellmans that patients “‘ought not to be treated merely as means to an end” but disagrees as he believes that clinical trials put patients in the situation where they become “means to a scientific end” rather than taking the patient’s well-being seriously (262). Freedman argues that clinical trials do not look out for the best interests of their patients but rather the science conclusions and advancements that researchers would gain from their experiments. When the
researchers start to put their research before the patients, the possibility and risk of mistreatment increases which is something that patients should beware and careful of when considering their participation in clinical trials.

The ethical dilemma is randomized clinical trials. When a physician suggests a clinical trial, it compromises the physician’s ability to regulate the treatment of the patient that they are going to receive. A physician is expected to suggest the best treatment for his/her patient and keep the patient’s interests in mind. However, this obligation may prevent the suggestion of trials to patients.

The “Either You Know Which Is Better or You Don’t” strategy states “Physicians should not recommend one treatment over another if they do not really know which is better, and they do not really know which treatment is better in the absence of data from randomized clinical trials” (264). This strategy suggests an “all or nothing” view on the of effectiveness of a trial. Either the physician has strong evidence or weak evidence but weak evidence suggests lack of confidence and speculation. If there is only weak evidence, the trial should not be suggested at all. The “Adopting a Less Strict Therapeutic Obligation” strategy suggests if a physician’s therapeutic obligation were less strict, enrolling a patient in trials does not put the patient in a less treated situation because there is no evidence that one treatment is better than the other.

Overall, Freedman argues that “a strict, thoroughly defensible, therapeutic obligation need not interfere with the conduct of randomized clinical trials” (266). Marquis’s solution is to combine both strategies. First, a physician should recommend a professional personal recommendation for the preferred type of treatment with an explanation of all the risks and benefits it may have. Secondly, the patient must give informed consent because it implies that the patient was informed and offered their participation in any clinical trial available even if the physician does not recommend it. It is important to value to the patient’s informed consent because it means if one treatment has weaker evidence than the other and the patient chooses that treatment, it is not considered unethical to go forth with the treatment because the patient chose to do so with the knowledge of the variety and choices the patient had for treatment. This allows the physician a chance to recommend a variety of treatments and the patient the opportunity to choose to join a trial and possibly get better treatment than the one the physician referred.

In 1932, the U.S Public Health Service conducted an experiment to gain more information about the course of untreated, latent syphilis in black males. Brant criticizes the study on moral grounds because the study put the research of scientists over the well-being of subjects. The Tuskegee study was extremely unethical because it denied their subjects, black males with syphilis, the right to be cured with penicillin. Brant refers to the study as the biggest example of unethical research in American history due to the racist beliefs that black Americans were going to extinct because of their “lust and immorality, unstable families and reversion to barbaric tendencies” (268).

At the beginning of the study, the scientists never had any intention of treating the patients, they only wanted the patients after they died to look at the course of syphilis and the effects it had on the human body.
The USPHS conducted the study and prevented the proper treatment of these patients to the extent that if they tried to reach medical attention from another health facility, they would be denied treatment. The scientists viewed and treated the patients as a part of those who had the a barbaric nature and would extinct from society. Overall, the study had no scientific or medical benefit but revealed the racism and discrimination the black Africans were subjected to. The patients were taken advantage of and mistreated in a vulnerable state of illness and
misinformed.

Brant believes the study violated the patient’s rights to informed consent. When conducting the study, there is no evidence of the patients being treated in the manner they were told. The patients chose to participate thinking they would receive “special free treatment” for their disease. They further those to continue the experiment because they were promised that burial expenses would be taken care of. However, this was the intention of the study in the first place. There was no intention of treatment but the scientists defended themselves saying that penicillin would not have worked on the patients and that they were lucky to have been given any treatment at all. Also, the lack of treatment jeopardized the health of the public by allowing contagious patients to go untreated especially during the advancement of penicillin. The study failed to maintain accurate records which would have probably shown evidence of the malpractice but also failed to protect patients and a community from a contagious disease. They refused the rights of a patient to informed consent and basic treatment.