J Med Ethics 31:149-152 doi:10.1136/jme.2003.006155
  • Research ethics

Sham surgery controls are mitigated trolleys

  1. R L Albin
  1. Correspondence to:
 Dr R L Albin
 4412D Kresge III, 200 Zina Pitcher Place, Ann Arbor, MI, 48109-0585, USA;
  • Received 7 August 2003
  • Accepted 19 January 2004
  • Revised 15 December 2003


Debate continues about the ethics of sham surgery controls. The most powerful argument for sham surgery controls is that rigorous experiments are needed to demonstrate safety and efficacy of surgical procedures. Without such experiments, there is danger of adopting worthless procedures in clinical practice. Opponents of sham surgery controls argue that sham surgery constitutes unacceptable violation of the rights of research subjects. Recent philosophical discussion has used two thought experiments—the transplant case and the trolley problem—to explore the circumstances under which individuals may be harmed to benefit a larger group. The transplant case is felt to exemplify circumstances that forbid harming some to benefit a larger group while the trolley problem exemplifies circumstances that permit harming some to benefit others. I argue that sham surgery controls satisfy criteria derived from the trolley problem and are morally permissible.


  • This study was supported by a VA Merit Review Grant and AG08671.