It is unethical to force a ‘volunteer’ to take the chance of being randomised onto the placebo arm of a trial  Under the status quo, someone with a terminal illness is offered two choices: death, or to join a trial (where such trials exist). However, when they join a trial they face the possibility that they will be given a placebo, not the drug.  Whilst this is probably in the best interest of future patients (a good clinical trial will determine the efficacy of the new treatment), it rides roughshod over the rights of the current patients (not to be sacrificed for future generations) and the duty of physicians to act in the best interests of their present patients.  There are two consequences here: the first is that it is morally dubious to use the present patients as mere means to an end, rather than acting in their own best interests, especially where, if randomized to the placebo arm the outcome of death is a certainty.  The second consequence is a practical one: compliance with the trial is lessened at the point at which patients can take alternative measures to increase their chance of survival. This was best documented during the early stages of the AIDS crisis in the 1980s, where there was evidence of ‘cheating’ during the trials1. People lied or bribed their way into clinical studies; and shared drugs to dilute the ‘risk’ of being on placebo.  This has the obvious impact of casting doubt on the scientific results of the trials: you can no longer be sure who has taken what, and what other conditions they may have.  1 Schüklenk, Udo, and Lowry, Christopher, ‘Terminal illness and access to Phase 1 experimental agents, surgeries and devices: reviewing the ethical arguments’, British Medical Bulletin, Vol.89, 2009, pp.7-22,