When deciding whether to offer deep brain stimulation earlier than usual for Parkinson disease, it is important to consider not only the patient’s autonomy but also the validity of the evidence and concepts of harm that are being used to form practice policies.
Clinical equipoise—the idea that the community of medical experts is uncertain about the relative therapeutic merits of the arms of a clinical trial at its outset—mitigates physicians’ responsibility for patients’ poor outcomes when patients are assigned to the control arm or are harmed by an investigational agent.
AMA J Ethics. 2015;17(12):1108-1115. doi:
10.1001/journalofethics.2015.17.12.ecas1-1512.
Decision-making capacity can be preserved in patients with mental illness and should be formally assessed in the context of their values and past decisions.
AMA J Ethics. 2017;19(5):416-425. doi:
10.1001/journalofethics.2017.19.5.ecas1-1705.
Withholding information from patients during an informed consent process is ethically unacceptable. Patients may restrict the amount of information they wish to receive or designate someone else to receive the information for them.
AMA J Ethics. 2015;17(3):209-214. doi:
10.1001/journalofethics.2015.17.3.ecas2-1503.
When a seriously ill mature minor and his parent disagree about his receiving an experimental intervention, who should decide what treatment he will receive?
Conducting community-based research in the community where one resides demands careful planning, sensitivity to community members’ privacy, and a strong commitment to full and respectful communication.
Elizabeth Lee Daugherty, MD, MPH and Douglas B. White, MD, MA
Opportunities to advance scientific knowledge may arise during humanitarian crises, but their presence does not justify suspension of the ethical foundations governing human subjects research.