Publication Details

Neil, D, The Emperor’s New Scar: The Ethics of Placebo Surgery, in Benatar, D (ed), Cutting to the core : exploring the ethics of contested surgeries, Rowman & Littlefiels, 2006. Original book available here.


[Extract] Surgical innovation is something of a grey area in medical research. Relative to other doctors, surgeons exercise a high degree of discretion in the trialing of new techniques with their patients. The first patients to undergo a new procedure are, in a real sense, subjects in an experiment. It is always hoped that a new procedure will deliver a clinical benefit but, as often as not, trial means error. The front-line patients bear a higher burden of risk, with lower expectation of success than subsequent patients, who benefit from the experience gained in the early attempts. ..... I will conclude by pointing out that there is one obvious way to ameliorate the problem of uncompensated harm, and that is to compensate. If participants volunteering for surgical research suffer complications, then they should receive not just treatment but also some monetary compensation for that suffering. Compensating for adverse outcomes is not the same as paying participants and cannot reasonably be construed as an inducement. My proposal is that fair compensatory payouts for various complications are determined in advance, and that this information is part of the informed consent process. I 22 believe this would help potential volunteers to appreciate the reality and relative seriousness of the risks they are being asked to accept. Such a scheme would require insurance coverage which would increase the cost of trials. If it is objected that this would make surgical trials too costly, that is equivalent to an admission that the funding of such research depends on unfair cost shifting onto trial subjects. The case of PCST offers a stark illustration of how the costs of medical progress are disproportionately borne by research subjects. If we are serious about eliminating exploitation in medical research, then patients who are harmed in such studies must be compensated.