Walking the Fine Line of Obligation

Imagine this hypothetical scenario:

You are a doctor, and one of your patients falls gravely ill; it is unlikely they will recover. However, you are aware of an experimental clinical trial taking place in your hospital testing a new drug which may be your patient's last best hope for survival, at least temporarily. While to place your patient in the trial would constitute a violation of the enrollment criteria of the trial, by doing so, you may save their life. What do you do?

If you are like 90 percent of clinicians surveyed in a recent survey by the Hastings Center, you may bend the restrictions to let your patient in. And why not? He or she has nothing to lose and everything to gain by participation in this trial. Where this becomes a sticky area is when one considers not how this course of action affects the individuals in the trial but how it affects the trial itself. Unhealthy patients, patients with a history of substance abuse, patients with chronic conditions, all of these have the potential to skew the results of drug tests or, by demonstrating catastrophic effects associated with their condition and not the drug, shut down trials on what would otherwise be a significantly less harmful drug.

The obligation to help people on an individual basis is a strong one, and part of the core of the medical profession. This is complicated, however, by the obligation posed by bioethics to serve the greater good. While a patient's continuing survival may hinge on access to an experimental drug, the survival of many more may hinge on that drug clearing the hurdles of clinical trials and becoming widely available. On the other hand, wouldn't doctors widely denying their patients access to that which might save their life be a more worrisome situation? The question is not one easily resolved.

Relevant Sites:
New York Times - Bending the Rules of Clinical Trials
The Hastings Center - Competing Commitments in Clinical Trials