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As most trials in critical care are funded from the public purse, we need an agreed solution. There should be a social responsibility for equipoise as we strive to create new evidence for patient benefit. Too often the lack of generalisable medical evidence means that complex decisions are based only on clinical experience and patient preference. A moral exit to this dilemma known as “clinical equipoise” is possible, since genuine uncertainty exists in the expert medical community at large; the investigator may thus continue to enroll control patients “blindly”, despite his or her bias. Clinical equipoise (ie, the idea that there should be genuine disagreement about which arm of a clinical trial is superior before initiation of the study) is conceptually flawed because the ethics. It is widely maintained that a clinical trial is ethical only if some form of equipoise between the treatments being compared obtains. To be in equipoise between two treatments a and b is to be cognitively indifferent between the statement 'a is strictly more effective than b' and its negation. The doctrine of clinical equipoise is appealing because it appears to permit physicians to maintain their therapeutic obligation to offer optimal medical care to patients while conducting randomized controlled trials (rcts). The appearance, however, is deceptive. Trials in contexts of high‐mortality diseases are morally suspect because equipoise does not exist between a standard of care that offers little prospect of clinical benefit and a umi that might offer some clinical advantage. Equipoise is a prima facie obligation rather than a morally authoritative principle for determining the acceptability of clinical trials. In its canonical formulation, clinical equipoise stipulates that a randomized controlled trial (rct) is only ethical insofar as there exists, at the outset, a state of genuine uncertainty in the community of medical experts about the relative therapeutic merits of every arm in the trial. T1 - equipoise in clinical trials. T2 - angst and progress. Au - rabinstein, alejandro a. Au - brinjikji, waleed. Au - kallmes, david f. N1 - funding information: disclosures dr kallmes received research support from medtronic, microvention, codman, neurosigma, surmodics, sequent medical, and shape memory therapeutics. Recall that the equipoise requirement was introduced to reconcile clinical research with clinical investigators' therapeutic obligations to their patients. To fully understand the rationale for equipoise, therefore, we must examine the general account of physicians' therapeutic obligations that it presupposes. This chapter argues that clinical equipoise does not offer sound ethical guidance regarding the appropriateness of randomized clinical trials as tools to generate the knowledge needed for drug approval or coverage decisions. Clinical equipoise, also known as the principle of equipoise, provides the ethical basis for medical research that involves assigning patients to different treatment arms of a clinical trial. The term was first used by benjamin freedman in 1987
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