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Clinical Equipoise and Moral Leeway: An Epistemological Stance
Clinical equipoise (CE) has been proposed as an ethical principle relating uncertainty andmoral leeway in clinical research. Although CE has traditionally been indicated as anecessary condition for a morally justified introduction of a new RCT, questions related tothe interpretation of this principle remain woefully open. Recent proposals to rehabilitateCE have divided the bioethical community on its ethical merits. This paper presents a newargument that brings out the epistemological difficulties we encounter in justifying CE asa principle to connect uncertainty and moral leeway in clinical ethics. The argumentproposes, first, that the methodology of hypothetical retrospection (HR) is applicable tothe RCT design and that it can accommodate uncertainty. As currently understood,however, HR should give up its reliance on the assumption of uncertainty transduction(UT), because the latter assumes the principle of indifference, which does notaccommodate uncertainty in the right way. The same principle is then seen to distort alsothe received interpretations of CE.