A critique of clinical equipoise: Therapeutic misconception in the ethics of clinical trials

This chapter explores the theoretical and practical problems associated with the similarity position and its logical offspring, clinical equipoise. It first considers the therapeutic misconception in the ethics of clinical trials before turning to the ethical distinction between research and therapy. It then turns to Charles Fried's arguments regarding the similarity position within bioethics, with particular emphasis on his assertion that answers to ethical dilemmas in research would have to be found within the ethics of therapeutic medicine. It also looks at the emergence of clinical equipoise as a doctrine in research ethics, along with the divorce between theory and practice as exemplified by placebo-controlled trials. The chapter concludes by launching a critique of the similarity position and clinical equipoise and calling for an alternative framework for the ethics ofclinical trials.