This essay explores some concerns about the quality of informed consent in patients whose autonomy is diminished by fatal illness. It argues that patients with diminished autonomy cannot give free and voluntary consent, and that recruitment of such patients as subjects in human experimentation exploits their vulnerability in a morally objectionable way. Two options are given to overcome this objection: (i) recruit only those patients who desire to contribute to medical knowledge, rather than gain access to experimental treatment, or (ii) provide prospective subjects the choice to participate in standard double-blind study or receive the experimental treatment. Either option would guarantee that patients in desperate conditions are given a more meaningful choice and a richer freedom, and thus a higher quality of informed consent, than under standard randomized trials.
Who fears to speak of Easter Week That week of famed renown When the boys in green went out to fight The forces of the Crown -Dublin Ballad, origins unknown 1In the fall of 1920, General Headquarters staff of the IRA realized that a new danger was facing them in their struggle for political independence from Britain. The British had begun to augment intelligence operations by organizing a special unit known as the Cairo Gang, whose mission was to execute the political leadership of Sinn Fein, including Michael Collins. 2 By October 1920 this unit had taken residence in Dublin and begun its nocturnal operations. In civilian clothes members of the Cairo Gang raided private homes and hotel rooms. Among those selected for execution were Dr. Fogarty, the Catholic Bishop of Killaloe (he wisely went away after the plot was described to him), the Lord Mayor of Limerick (murdered in his home), a former Lord Mayor of Limerick, Alderman George Clancy, John Lynch, a Kilmallock businessman (shot dead in his bed at 2 A.M.), and Arthur Griffith, then Acting President of Sinn Fein, among others.As a result of fortuitous circumstances, Michael Collins was able to piece together information on the main figures in the plot to break Sinn Fein. His strategy to paralyze British operations during this critical period in Irish independence was simple and successful: identify the members of this unit and other high-ranking British personnel, gather irrefutable evidence, and then assassinate them. Subsequently, names and addresses of thirty-five British Secret Service officers were secured and presented to Michael Collins by his staff. Detailed reports were prepared on each of them. Fifteen were rejected on grounds of insufficient evidence. The remaining twenty were chosen for assassination.
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