Theoretical and Applied Ethics 3 (1):35-59 (2014)

The concept of equipoise is considered by many to be part of the ethical justification for using human subjects in clinical research. In general, equipoise indicates some uncertainty about the relative merits of the experimental intervention compared to existing treatments. Relieving this uncertainty gives scientific value to an experiment, thereby making the risks to human subjects in the trial acceptable, other considerations notwithstanding. But characterizing equipoise remains controversial since Freedman’s groundbreaking publication on the subject. We offer a new account of equipoise that draws on and extends an option Freedman discarded. After establishing the importance of some account of equipoise as part of ethically justified clinical trials, we revisit Freedman’s distinction between clinical and theoretical equipoise. We raise concerns about Freedman’s preferred clinical equipoise and then rehabilitate theoretical equipoise. In particular, we use a variety of arguments from epistemology to show how Freedman was too hasty in rejecting theoretical equipoise. In addition, we argue that theoretical equipoise is a subspecies of epistemic equipoise, which we characterize as a form of uncertainty that is the result of the possibility of error. This type of uncertainty can best be alleviated by research, which produces beliefs supported by strong statistical evidence, which is a key aim of clinical trials. Further, this type of uncertainty can explain why even clinicians with more firsthand experience with an intervention than their peers, and who may not be in theoretical equipoise, could still justifiably support a trial designed to ameliorate the possibility of error due to cognitive bias.
Keywords No keywords specified (fix it)
Categories No categories specified
(categorize this paper)
Edit this record
Mark as duplicate
Export citation
Find it on Scholar
Request removal from index
Revision history

Download options

PhilArchive copy

Upload a copy of this paper     Check publisher's policy     Papers currently archived: 71,172
External links

Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
Through your library

References found in this work BETA

No references found.

Add more references

Citations of this work BETA

No citations found.

Add more citations

Similar books and articles

Clinical Equipoise: Actual or Hypothetical Disagreement?Scott Gelfand - 2013 - Journal of Medicine and Philosophy 38 (6):590--604.
What Kind of Principle Is Clinical Equipoise?Luca Chiapperino & Cecilia Nardini - 2014 - Theoretical and Applied Ethics 3 (1):1-16.
Uncertainty and the Ethics of Clinical Trials.Sven Ove Hansson - 2006 - Theoretical Medicine and Bioethics 27 (2):149-167.
Community Equipoise and the Architecture of Clinical Research.Jason H. T. Karlawish & John Lantos - 1997 - Cambridge Quarterly of Healthcare Ethics 6 (4):385-396.
Community Equipoise and the Architecture of Clinical Research.Jason H. T. Karlawish & John Lantos - 1997 - Cambridge Quarterly of Healthcare Ethics 6 (4):385-.
So-Called "Clinical Equipoise" and the Argument From Design.Fred Gifford - 2007 - Journal of Medicine and Philosophy 32 (2):135 – 150.
The Real Problem with Equipoise.Winston Chiong - 2006 - American Journal of Bioethics 6 (4):37 – 47.
The Irrelevance of Equipoise.Robert M. Veatch - 2007 - Journal of Medicine and Philosophy 32 (2):167 – 183.


Added to PP index

Total views
7 ( #1,071,368 of 2,517,896 )

Recent downloads (6 months)
1 ( #409,045 of 2,517,896 )

How can I increase my downloads?


My notes