Since it was introduced around 1987, Freedman's principle of the clinical equipoise has arguably obtained a widespread uptake in the bioethics discourse. Equipoise is the requirements of ethical principle within the clinical study which includes the favorable risk-benefit ration and the scientific validity ( Anderson, 2009). Equipoise is arguably the prima facie responsibility instead of the morally authoritative standard for the determination of the suitability of any clinical trial. Therefore, it must be balanced efficiently against the rest of the existing standards for the clinical study. Arguably, the possible contravention of equipoise might not be considered as being unethical in all cases. However, in the recent years, the clinical equipoise has experienced a mounting consensus that it is fundamentally flawed.
According to Freedman, before any trial is initiated, there has to be a genuine ambiguity in expert’s medical communities concerning the favored medication. The concept’s definition, according to Freedman is arguably extensive within clinical study; however, it is highly contentious. The equipoise disagreement has gradually become intricate. According to Freedman, the medical community has determined which treatment is most effective. Anderson (2009) asserts that the c linical investigators may only conduct a clinical trial if he is in equipoise. However, this is evidently a key concern as data accumulates, there would be perceptible trends that favors a given treatment before the point of achieving the objective of the trail. Freedman's 'clinical equipoise' clearly offers a possible solution to such a dilemma. Freedman developed two critical contrasts with equipoise on being regarding the individual versus the community equipoise and the other one concerned with the theoretical and clinical equipoise, but none of them entirely resolves the dilemma.
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The original discussion by Freedman structured the issues in the most deceptive approach thus making things highly imperceptible. Based on Freedman, the clinical equipoise is significantly conflated with community equipoise, and also numerous accounts are conflated. Freedman disagrees that the clinical trials tend to entail physician-researchers not giving what they judge to be the best care to their patient-subjects instead; he noted that RCTs do not necessarily respect the right to treatment of the patients and rights should be recognized and respected ( Gifford, 2000). Not everyone has the right to treatment, and such reason is founded on the need of the patient. Critic state that if the physician suspects that a given treatment is better or even worse than the other, then he cannot be in equipoise. However, Freedman believes that such a perspective of the equipoise is mistaken. He posits that an actual equipoise does not entirely rely on the uncertainties in physicians but authentic divergence within medical communities concerning the worth of the treatment because of a lack of appropriate substantiation gleaned from the randomized clinical trial. Therefore, when such doubts exist then the randomized clinical study is permissible.
References
Anderson, J. A. (2009). Contextualizing clinical research: the epistemological role of clinical equipoise. Theoretical medicine and bioethics , 30 (4), 269-288.
Gifford, F. (2000). Freedman's' clinical equipoise'and sliding-scale all-dimensions- considered equipoise'. The Journal of medicine and philosophy , 25 (4), 399-426.
