trials unethical? American Journal of Bioethics 2(2):3–9. Exploitation and the Ethics of Clinical Trials

based on historical comparisons, and proofs derived from randomized clinical trials. Effectiveness might mean dis-ease stability, a minor response, a complete response, or a cure. Rational patients might ªnd the proof of a “proven effective treatment ” insufªciently rigorous or the effective-ness of the treatment unacceptably minimal and for either of those reasons choose an experimental therapy even if that entailed the risk of drawing a placebo. It is neither wise, necessary, nor justiªed to compartmentalize the eth-ics of clinical research and the ethics of clinical care in a manner that relieves clinical investigators of the responsi-bility to provide optimal medical care