Clinical equipoise and the incoherence of research ethics

Howard Brody

Research output: Chapter in Book/Report/Conference proceedingChapter


This chapter examines the doctrine of clinical equipoise within the context of research ethics. It first considers the two components of clinical equipoise that are often erroneously conflated: the "honest null hypothesis" principle and the "no inferior treatment" principle. It then turns to instances of theoretical and practical incoherence in research ethics attributable to endorsing clinical equipoise as a fundamental principle, with particular emphasis on the incoherence of the therapeutic orientation to clinical trials and incoherence in risk-benefit assessment. It argues that clinical equipoise's basic appeal to the ethics of therapeutic medicine is misguided, since no ethical physician would treat patients in the way that clinical equipoise would allow research participants to be treated, and that clinical equipoise cannot be rendered coherent merely by carving out exceptions. Finally, the chapter discusses the non-exploitation framework by addressing the views of Jansen (2005).

Original languageEnglish (US)
Title of host publicationThe Ethical Challenges of Human Research
Subtitle of host publicationSelected Essays
PublisherOxford University Press
ISBN (Electronic)9780190267681
ISBN (Print)9780199896202
StatePublished - Nov 15 2012
Externally publishedYes


  • Clinical equipoise
  • Clinical trials
  • Honest null hypothesis
  • No inferior treatment
  • Non-exploitation
  • Research ethics
  • Rrisk-benefit assessment
  • Therapeutic medicine
  • Therapeutic orientation

ASJC Scopus subject areas

  • General Arts and Humanities


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