Patients have particular problems grasping abstract, as opposed to concrete, information. Consequently, fully informed consent for all patients at least is an unobtainable ideal. The authors favour the third option. While difficulties with communication are regrettable and should be reduced as much as possible, some failure would appear inevitable. It is therefore important that the patient understands that equipoise exists, and so has realistic expectations.
Conclusions is a bullet.
The caring professions must articulate clear, ethical justification for trials if public confidence is to be retained. Patients should not lose out in prospect by taking part in a trial. Given treatments which are generally available, patients do not lose out in prospect when prior estimates of effectiveness and values interact to produce equal expected utilities. When treatments are not generally available, patients do not lose out by participating in trials when the expected utility of the new treatment is at least as high as that of standard treatment. The term 'uncertainty' prevaricates on prior probabilities and values, making it an inadequate moral basis for trials.