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Is it in a neonate's best interest to enter a randomised controlled trial?

Allmark, P., Mason, S., Gill, A.B. and Megone, C. (2001) Is it in a neonate's best interest to enter a randomised controlled trial? Journal of Medical Ethics, 27 (2). pp. 110-113. ISSN 1473-4257

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Abstract

Clinicians are required to act in the best interest of neonates. However, it is not obvious that entry into a randomised controlled trial (RCT) is in a neonate's best interest because such trials often involve additional onerous procedures (such as intramuscular injections) in return for which the neonate receives unproven treatment or a placebo. On the other hand, neonatology needs to develop its evidence base, and RCTs are central to this task. The solution posited here is based on two points. First, "best interest" is not equivalent to "the best possible interest" only to "best interest within a certain realm". The realm of deliberation when asking the title question is the neonate's health. Deliberating in this realm may involve the exclusion from consideration of some factors that might be thought relevant (such as parental wealth). Furthermore, circumstances may dictate the need to deliberate on other factors that might be thought irrelevant (such as health care resources). Second, deciding on a neonate's best interest does not involve "putting oneself in its shoes". Rather, it involves asking in what it has an interest, or stake. These will include some things in which we all, as human beings, have a stake, such as medical progress. Putting these two points together, in the realm of health the answer to whether RCT entry is in a neonate's best interest is usually very finely balanced. Where this is the case, it is reasonable to invoke a broader notion of best interest and include a broader range of elements in which the neonate has a stake, including medical progress. In this way RCT entry can, usually, be said to be in a neonate's best interest.

Item Type: Article
Copyright, Publisher and Additional Information: © 2001 Megone, C., Allmark, P., Mason, S. and Gill, A.B. Reproduced in accordance with the publisher's self-archiving policy.
Institution: The University of Leeds
Academic Units: The University of Leeds > Faculty of Arts (Leeds) > School of Humanities (Leeds) > School of Philosophy (Leeds)
Depositing User: Leeds Philosophy Department
Date Deposited: 02 Nov 2007 18:54
Last Modified: 08 Feb 2013 17:06
Published Version: http://jme.bmj.com/cgi/content/full/27/2/110
Status: Published
Publisher: BMJ Publishing Group
Refereed: Yes
Identification Number: 10.1136/jme.27.2.110
URI: http://eprints.whiterose.ac.uk/id/eprint/3339

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