A DESPERATE SOLUTION - INDIVIDUAL AUTONOMY AND THE DOUBLE-BLIND CONTROLLED EXPERIMENT

The randomization ingredient in double-blind controlled experiments ma y be objectionable to patients who, in their desperation, come to such trials seeking a last chance of cure. Minogue et al., who view such a situation as inherently exploitive and undermining of patient autonom y, propose that such ''desperate volunteers'' instead be enrolled in t he active arm, while other patients, less desperate and more committed to medical progress, continue to be randomized. Their view is critiqu ed as destructive of medical progress, inappropriate in its lack of cl inical response to such patients, and fatally flawed by unrealistic no tions of autonomy and voluntariness.