Equipoise and the Ethics of the Canadian Lung Volume Reduction Surgery Trial study: Should There Be a Randomized, Controlled Trial to Evaluate Lung Volume Reduction Surgery?
The physical improvement is so great following lung volume reduction surgery that there is growing opinion that a randomized, controlled trial is unnecessary. A randomized, controlled trial, it is argued, would deprive those patients randomly assigned to the nonsurgical treatment arm the 'benef...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2000-01-01
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| Series: | Canadian Respiratory Journal |
| Online Access: | http://dx.doi.org/10.1155/2000/853215 |
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| _version_ | 1832565896833400832 |
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| author | John D Miller Michael D Coughlin Lori Edey Patricia Miller Yasmin Sivji |
| author_facet | John D Miller Michael D Coughlin Lori Edey Patricia Miller Yasmin Sivji |
| author_sort | John D Miller |
| collection | DOAJ |
| description | The physical improvement is so great following lung volume reduction surgery that there is growing opinion that a randomized, controlled trial is unnecessary. A randomized, controlled trial, it is argued, would deprive those patients randomly assigned to the nonsurgical treatment arm the 'benefit' of lung volume reduction surgery. Entering a trial in which one arm leads to a surgical intervention and the other to best medical management also poses a variety of ethical difficulties. If one is to be offered surgery, there must be perceived benefit because the physician has an obligation to offer the best possible treatment for his or her patient. If a patient agrees to have surgery, the expectation is that surgery would help. Thus, a patient randomly assigned to the medical arm of a trial may easily believe that he or she is being deprived of surgery that may help them. This paper illustrates this dilemma using the Canadian Lung Volume Reduction Surgery Trial. The authors discuss the concept of 'equipoise' in three dimensions, adding community equipoise to theoretical equipoise and clinical equipoise earlier described by Freedman. The paper concludes that the Canadian Lung Volume Reduction Surgery Trial needs to continue because of the clinical equipoise that drives it. |
| format | Article |
| id | doaj-art-f66462a6a8ae49d88bebce725cd92c2e |
| institution | Kabale University |
| issn | 1198-2241 |
| language | English |
| publishDate | 2000-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Respiratory Journal |
| spelling | doaj-art-f66462a6a8ae49d88bebce725cd92c2e2025-02-03T01:06:19ZengWileyCanadian Respiratory Journal1198-22412000-01-017432933210.1155/2000/853215Equipoise and the Ethics of the Canadian Lung Volume Reduction Surgery Trial study: Should There Be a Randomized, Controlled Trial to Evaluate Lung Volume Reduction Surgery?John D Miller0Michael D Coughlin1Lori Edey2Patricia Miller3Yasmin Sivji4Division of Thoracic Surgery, St Joseph’s Hospital, McMaster University, CanadaHospital Ethics Service, St Joseph’s Hospital, CanadaPastoral Education, McMaster University, CanadaPhysiotherapy, McMaster University, CanadaCanadian Lung Volume Reduction Surgery National Trial Coordinator, McMaster University, Hamilton, Ontario, CanadaThe physical improvement is so great following lung volume reduction surgery that there is growing opinion that a randomized, controlled trial is unnecessary. A randomized, controlled trial, it is argued, would deprive those patients randomly assigned to the nonsurgical treatment arm the 'benefit' of lung volume reduction surgery. Entering a trial in which one arm leads to a surgical intervention and the other to best medical management also poses a variety of ethical difficulties. If one is to be offered surgery, there must be perceived benefit because the physician has an obligation to offer the best possible treatment for his or her patient. If a patient agrees to have surgery, the expectation is that surgery would help. Thus, a patient randomly assigned to the medical arm of a trial may easily believe that he or she is being deprived of surgery that may help them. This paper illustrates this dilemma using the Canadian Lung Volume Reduction Surgery Trial. The authors discuss the concept of 'equipoise' in three dimensions, adding community equipoise to theoretical equipoise and clinical equipoise earlier described by Freedman. The paper concludes that the Canadian Lung Volume Reduction Surgery Trial needs to continue because of the clinical equipoise that drives it.http://dx.doi.org/10.1155/2000/853215 |
| spellingShingle | John D Miller Michael D Coughlin Lori Edey Patricia Miller Yasmin Sivji Equipoise and the Ethics of the Canadian Lung Volume Reduction Surgery Trial study: Should There Be a Randomized, Controlled Trial to Evaluate Lung Volume Reduction Surgery? Canadian Respiratory Journal |
| title | Equipoise and the Ethics of the Canadian Lung Volume Reduction Surgery Trial study: Should There Be a Randomized, Controlled Trial to Evaluate Lung Volume Reduction Surgery? |
| title_full | Equipoise and the Ethics of the Canadian Lung Volume Reduction Surgery Trial study: Should There Be a Randomized, Controlled Trial to Evaluate Lung Volume Reduction Surgery? |
| title_fullStr | Equipoise and the Ethics of the Canadian Lung Volume Reduction Surgery Trial study: Should There Be a Randomized, Controlled Trial to Evaluate Lung Volume Reduction Surgery? |
| title_full_unstemmed | Equipoise and the Ethics of the Canadian Lung Volume Reduction Surgery Trial study: Should There Be a Randomized, Controlled Trial to Evaluate Lung Volume Reduction Surgery? |
| title_short | Equipoise and the Ethics of the Canadian Lung Volume Reduction Surgery Trial study: Should There Be a Randomized, Controlled Trial to Evaluate Lung Volume Reduction Surgery? |
| title_sort | equipoise and the ethics of the canadian lung volume reduction surgery trial study should there be a randomized controlled trial to evaluate lung volume reduction surgery |
| url | http://dx.doi.org/10.1155/2000/853215 |
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