Kantians would object, however, if the investigators use patients merely as the means to societal ends and, given voluntary consent, this is not the case. When equipoise applies, patients do not lose out prospectively, in order to benefit others. Given equipoise, a trial should be acceptable to both utilitarians and Kantians, and hence ethical in its use of patients. Further argument concerns the idea of uncertainty as a moral basis for trials as well as the significance of different, less ambiguous, constructs, i.e. collective versus individual equipoise. It is evident that patients are unlikely to understand all the information which is given to them by whatever means during consent consultations.
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.