Case Two: A Kantian Approach to the Morality of Blood Substitute Clinical Trials Without Informed Consent

Extract

Clinical trials in a number of countries are now underway to evaluate experimental, non-human blood substitute.¹ One scenario calls for the blood substitute to be available on board emergency vehicles. This allows first responders the opportunity to provide transfusion support at an accident site and on the way to the hospital. However, many of the patients who would most benefit from the use of this material may be unconscious and unable to comprehend or sign an informed consent. One possible solution would be to eliminate the need for informed consent.

The ethical question posed by this scenario is penetrating: Is it moral to use an experimental, non-human blood substitute to provide on-site transfusions without the patient's informed consent? At first blush, assuming the blood substitute is effective, commonsense morality might uphold its moral permissibility both because the patient's life could be saved and because the knowledge gained from such trials may save lives. This view fits a position in normative ethics called consequentialism; the view that the only factors relevant to an action's moral worth are its consequences.² As Shelly Kagan puts it, “If an act will have bad results, that is a reason not to perform it; if, on the other hand, it will have good results, then that is a reason to perform it.”³

However, since a requirement forcing medical personnel to obtain informed consent could have negative consequences with no obvious countervailing benefits, the consequentialist appears committed to the claim that medical personnel have an obligation not…