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The Hastings Center




In prospective interventional research, a treatment may provide an advantage for the recipient over other humans not receiving it. If the intervention proves successful, the treated are better able to compete for a scarce ventilator, a class grade, or a litigation outcome, potentially risking the deaths, jobs, or incomes of non-treated persons. The concerns for “bystanders” have typically focused on direct harms (e.g., infecting them with a virus), unlike the mere competition for rivalrous goods at issue here.

After broadly scoping this problem, analysis reveals several reasons that such research is typically permissible, notwithstanding the potential setbacks to the interests of non-participants. After considering the almost-dispositive concept of clinical equipoise, insights are gleaned from the harm principle, status quo bias, the levelling-down problem, and a potential bias against prospective interventional research versus program interventions with retrospective study. Consideration of institutional relationships also does not change the analysis that such research is permissible.

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