Emergency Preservation and Resuscitation Trial: A Philosophical Justification for Non-Voluntary Enrollment.

In a current clinical trial for Emergency Preservation and Resuscitation (EPR), Dr. Samuel Tisherman of the University of Maryland aims to induce therapeutic hypothermia in order to 'buy time' for operating on victims of severe exsanguination. While recent publicity has framed this controversial pro...

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Publicado en:Bioethics Vol. 30; no. 5; pp. 344 - 353
Autor principal: Tigard, Daniel
Formato: Artículo
Publicado: Wiley-Blackwell Jun2016
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Acceso en línea:Ver este registro en EBSCOhost
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        Therapeutics
        Emergency medical services
        Critical care medicine
        Informed consent (Medical law)
        Ethics
        Human research subjects
        Clinical trials & ethics
        Hemorrhage prevention
        Induced hypothermia
        Cardiac arrest
        Resuscitation
        Decision making in clinical medicine
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        subj:
          Therapeutics
          Emergency medical services
          Critical care medicine
          Informed consent (Medical law)
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          Emergency and Other Relief Services
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          Cardiac arrest
          Resuscitation
          Decision making in clinical medicine
      keyword:
        critical care
        double‐effect
        double-effect
        emergency preservation and resuscitation
        Hans Jonas
        informed consent
        research ethics
        critical care
        double‐effect
        double-effect
        emergency preservation and resuscitation
        Hans Jonas
        informed consent
        research ethics
      ab: In a current clinical trial for Emergency Preservation and Resuscitation (EPR), Dr. Samuel Tisherman of the University of Maryland aims to induce therapeutic hypothermia in order to 'buy time' for operating on victims of severe exsanguination. While recent publicity has framed this controversial procedure as 'killing a patient to save his life', the US Army and Acute Care Research appear to support the study on the grounds that such patients already face low chances of survival. Given that enrollment in the trial must be non-voluntary, the study has received an exemption from federal standards for obtaining informed consent. How exactly, if at all, is non-voluntary enrollment morally justifiable? In this essay, I appeal to the notable work of Hans Jonas in an effort to defend the EPR trial's use of non-voluntary enrollment. It is often thought and, as I show, it may appear that Jonas has called for the end of experimental medical practice. Still, I derive from Jonas a principle of double-effect upon which physicians may be seen as morally permitted to pursue innovations in emergency medicine but only as a byproduct of pursuing therapeutic success. With this position, I argue that the EPR trial can be granted a stronger philosophical justification than simply waiving the requirement of obtaining informed consent. The double-effect justification would obtain, perhaps regardless of the success of such innovative procedures as therapeutic hypothermia.
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