But we get it. Many people have ethical concerns that go beyond these standards. The study participants are often particularly vulnerable populations and many legal service providers are in this profession specifically to help people in need. Many of these cases involve life events for which the stakes are high: safety, shelter, health, and so forth. Access to legal services in many cases can end up being a critical lifeline. You are all likely acutely aware of the tenuous resources in the legal services world: federal and state funding levels cause significant anxiety every year, Interest on Lawyer Trust Accounts continue to decline, and courts are facing budget cuts that are driving some of them to reduce hours of operation.
The unmet legal needs are significant. In this resource-constrained context we cannot provide services to everyone, and some mechanism must determine who receives services and who does not. It also might look like a lottery, where some impartial system allocates resources and determines service recipients randomly. The point is, we are already unable to provide services to everyone. A lottery is one of several options we have for making such determinations, and, in cases where services are already distributed by lottery, is one we already use.
So it is frequently ethical to use a lottery to allocate the scarce resource certain kinds of legal help, court-sponsored mediation, etc. The other important factor is equipoise. Essentially, the concept of equipoise means that we do not already know whether the way we are allocating resources or providing services is the most effective way.
Because we have no established tradition in the law for conducting rigorous research on effectiveness, we have subsisted for years based on policy preferences, professional judgments, or educated guesses rather than evidence. Thus, in all of our studies, we are operating in a state of profound uncertainty that justifies the use of a lottery randomization to find out what works. Consider the chart below to think about how both equipoise and resource scarcity interact.
The left column shows possible positive outcomes for a person working to solve a legal issue with some less expensive form of legal assistance, say, self-help materials. The right column shows possible positive outcomes for that person were she to receive an expensive form of legal assistance, say, a traditional attorney-client relationship. The third line in which a higher level of assistance cause a worse outcome appears in strike-through because, we surmise, it happens to infrequently that it is safe to ignore.
Specifically, note that in some of these hypotheticals, legal assistance changes the outcome and, in other hypotheticals, the legal intervention does not make a difference. Subscribe to the newsletter. When Disease Gets News Coverage.
News Staff. It is difficult for pharmaceutical companies to have good public relations in an immediate news and social media world - no matter how many trials are done, people can still have adverse effects or even suffer real harm - and social media detractors can just claim they are corrupt and convince a large segment of their followers. To make sure the public has as much confidence as possible in new products, all drugs have to undergo exhaustive, time-consuming and expensive testing.
In a letter to The Lancet , 17 senior health professionals and medical ethicists from Africa, Europe, and USA, argue that randomized controlled trials are not needed for ebola, because the lack of effective treatment options and high mortality with the current standard of care means that alternative trial designs need to be considered.
None of us would consent to be randomised in such circumstances. In cancers with a poor prognosis for which there are no good treatments, evidence from studies without a control group can be accepted as sufficient for deployment, and even for licensing by regulators, with fuller analysis following later.
There is no need for rules to be bent or corners to be cut: the necessary procedures already exist, and are used. We have innovative but proven trial designs for doing exactly that. We should be using them, rather than doggedly insisting on gold standards that were developed for different settings and purposes.
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