Your loved one has had a heart attack, and is unconscious. An ambulance rushes to your home, and the technician had a choice: start with CPR, or zap the patient with electrified paddles right away.
How would you feel if, at that moment, the EMT flipped a coin to decide treatment?
This type of scenario raises red flags for bioethicists. Add to it that the randomized choice of care is part of a research trial, and it’s not difficult to see the medical intervention as a sinister assault on a vulnerable patient.
There are two big concerns with experimental trials that take place without the consent of critical care patients. One is practical: we don’t want to use experimental therapies that end up being less successful than present treatments. The other is principled: we don’t want to force treatments upon patients. Combined, the objection becomes more vivid: we don’t want to compel patients to risk bad medicine.
If we poke about, there’s another gut reaction lurking in the background. Even if the patient has given informed consent, we don’t like research strategies where patients are just a way to get something else done – a means to an end. It promotes risks we dare not tolerate, and offends the view that we should be treated first and foremost as precious individuals who have interests deserving of protection and care. (A neo-Kantian would toss in the idea of ‘human dignity’, but I’ll give that a pass.)
With this in mind, I’d normally side with the majority of bioethicists; informed consent is a good thing, even though it may have less of a presence in modern medicine than some philosophers might think it should.
However, I’ll depart from George Annas and others quoted in the Washington Post’s item, Critical Care Without Consent. My reasoning is simple, and has nothing to do with the benefits that might come from the study. Instead, it has to do with medical ignorance under conditions where, in at least some cases, informed consent doesn’t matter much.
The controversial research trials by the Resuscitation Outcomes Consortium involve treatments for which there are now only arbitrary choices. This means that right now, there is no such thing as informed consent. Doctors and emergency medical technicians are already flipping coins – and if they weren’t, patients would be doing it for them. When we don’t know what to so, it makes sense to organize and record the many arbitrary choices that are already being made, and learn what we can.