ABSTRACT
In the wake of a surge of interest in health services research, there has been increased interest in experimentation conducted in the field with living human subjects. These experiments are randomised controlled trials, in which participants are allocated by chance to a conventional treatment or to one of as yet unproven effectiveness and safety. Some claim that such trials are fundamentally unethical because patients can never be used as a means to an end, or because the requirements of trials are fundamentally at odds with the responsibilities of the doctor looking after the patient. The legal model requires complete disclosure which, in research as in clinical practice, is scarcely feasible given that possibilities of adverse effect are essentially infinite. The nature of the clinical contract rules out the possibility that the doctor could simultaneously offer best judgments on individual care and, at the same time, act in the interests of medical science.
