Taking the Train to a World of Strangers: Health Care Marketing and Ethics

The marketing of health care services raises the prospect that an ethic of strangers will govern relations between providers and patients. A fiduciary model that emphasizes honesty and public accountability, as well as the patient's good and avoiding unnecessary services, can keep marketing consistent with the ethical tradition of medicine.     

The Real‐World Ethics of Adaptive‐Design Clinical Trials

From the earliest application of modern randomized controlled trials in medical research, scientists and observers have deliberated the ethics of randomly allocating study participants to trial control arms. Adaptive RCT designs have been promoted as ethically advantageous over conventional RCTs because they reduce the allocation of subjects to what appear to be inferior treatments. Critical assessment of this claim is important, as adaptive designs are changing medical research, with the potential to significantly shift how clinical trials are conducted. Policy‐makers are swiftly moving to encourage greater use of adaptive designs. In 2016, the newly enacted 21st Century Cures Act instructed the Food and Drug Administration to help product sponsors incorporate adaptive methods into proposed clinical trial protocols and applications for investigational drugs and also biological products. In this article, we review the ethical justifications commonly offered for adaptive designs, explore these arguments in the context of actual trials, and contend that clinical equipoise is a useful standard for adaptive‐trial ethics. We distinguish between theoretical and clinical equipoise and explain why ethical arguments related to adaptive trials tend to focus on the former. Yet we contend that theoretical equipoise can be an unreliable standard for adaptive ethics. While we contend that clinical equipoise is the most critical principle for the primary ethical concerns posed by adaptive trials, we suggest ethical approaches to deal with some additional concerns unique to adaptive designs.     

Biomedical value conflict

Diversity among Scandinavian countries' policies on such biomedical issues as prenatal diagnosis, artificial insemination, and reimbursement for treatment provided by a foreign country illustrates the powerful influence of cultural context on bioethics and underscores the need for tolerance of the moral autonomy of nations governed by a pragmatic set of conditions for the management of value conflict.     

The Ethics of Teaching Ethics

Concerns of public responsibility and professional certification may sometimes mean it is unethical to teach ethics.     

Ethics by the Book

Book reviewed in this article: Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine . By Albert R. Jonsen, Mark Siegler, and William J. Winslade     

Medical Ethics the Japanese Way

An American in Tokyo finds that the Japanese cultural values of consensus and deference to authority characterize their approach to ethical issues in health care.     

Ethics and the Military Community

Book reviewed in this article: War, Morality, and the Military Profession . Edited by Malham M. Wakin.