J Med Ethics 24:401-408 doi:10.1136/jme.24.6.401
  • Research Article

Can unequal be more fair? Ethics, subject allocation, and randomised clinical trials.

  1. A L Avins
  1. Veterans Affairs Medical Center, San Francisco, USA.


      Randomised clinical trials provide the most valid means of establishing the efficacy of clinical therapeutics. Ethical standards dictate that patients and clinicians should not consent to randomisation unless there is uncertainty about whether any of the treatment options is superior to the others ("equipoise"). However, true equipoise is rarely present; most randomised trials, therefore, present challenging ethical dilemmas. Minimising the tension between science and ethics is an obligation of investigators and clinicians. This article briefly reviews several techniques for addressing this issue and suggests that unbalanced randomisation, a technique rarely employed in current clinical trial practice, may be useful for enhancing the ethical design of human experimentation.

      Relevant Article

      Free sample
      This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of JME.
      View free sample issue >>

      Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

      Navigate This Article