People who participate in placebo-controlled trials are taking chance on them: they might get the treatment,
and they might better, or they might get placebo, in which case they stay the same. Angell argues it is morally
wrong to run randomized, placebo-controlled clinical trials in developing countries. (Some examples: HIV
regimen without AZT zidovudine, prophylaxis against tuberculosis)
For this writing assignment, please do the following:
First, reconstruct Angell’s main argument in premise-conclusion form. (Hint: her main argument appears in the
first paragraph.) The first premise should be a general moral principle, taking the form “If…then…” or “…only
if…” (Sometimes one phrasing is more natural than the other, even though they are logically equivalent.)
Although you’re welcome to be more creative (without sacrificing clarity), here’s a template you can use–your
job is to correctly fill in the blank(s):
Premise 1: It is morally permissible to run a randomized, placebo-controlled trial comparing two treatments for
a condition only if __________ .
Premise 2: It is not the case that __________.
Conclusion: Therefore, it is morally impermissible to run a randomized, placebo-controlled trial.
Second, motivate the premises–i.e. provide at least one reason to think Premise 1 is true and at least one
reason to think Premise 2 is true.
Third, challenge the premises–i.e. provide at least one reason to think Premise 1 is false (i.e. at least one
reason to think that randomized, placebo-controlled trials can be permissible even if the statement you put in
the blank is false) and at least one reason to think Premise 2 is false (i.e. at least one reason to think the
statement you put in the blank is true).
Fourth, answer the following questions concerning some of Angell’s key claims:
C1. “Subjects in the control group must receive the best known treatment”
Q1: Is this always true? Why or why not?
C2. “Goals of the research are always secondary to the well-being of the participants”
Q2: Is this true? Can you think of any exceptions? If so, what are some?
C3. “Informed consent, important though it is, is not protection enough”
Q3: Why not? Do you think Angell right about this? Why or why not?
C4. “With the most altruistic of motives, then, researchers may find themselves slipping across a line that
prohibits treating human subjects as means to an end.”
Q4: Are we ever justified in treating others as means to an end? If so, what might be an example? If not, why
C5. Angell regularly appeals to the standards of research set forth in the Declaration of Helsinki and other
Q5: Might the Declaration of Helsinki (etc.) be wrong in some cases? If so, how? If not, why not?