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By Basil A. Stoll

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But if physicians do disclose their treatment preferences, even if accompanied by warning that the medical profession is divided on the issue, few patients may then be willing to have their treatment chosen by a 'flip of the coin'. The point is that physicians will seldom be truly indifferent to the alternatives being tested. And, as discussed above, even when the physician is truly indifferent, the patient's attitudes and values will often be more consistent with one treatment than another. For example, in the NSABP trial, some patients would prefer to err on the side of safety, while others would accept greater risks of mortality in order to minimize aesthetic impairment.

4. A CONFLICT OF ROLE FOR THE PHYSICIAN-RESEARCHER Many physicians who both treat patients and, simultaneously, carry out clinical research, feel some ethical concern that they may only be able to carry out their scientific commitments adequately by sacrificing their obligation to deliver optimal care to every patient. The possibility of conflict between the role of personal physician and the role of research scientist arises from the fact that each role is defined by reference to a different primary purpose: either to provide optimal patient care (consistent with the informed wishes of the patient), or to pursue the acquisition of scientific knowledge.

The pressure of scientific and technological advances is, however, changing clinical freedom, so that cancer treatment is now less governed by personal opinion. Attempts are constantly being made by scientifically-controlled trials to compare the effectiveness of different treatments. However, the results may be either ignored or else interpreted by some physicians as a restriction and a threat to their clinical freedom to practise as they see fit. Is it a restraint on the freedom of the hospital physician for him not to be able to order new instruments regardless of cost; to be restricted by a hospital drug guide; to use standard surgical appliances which can be bought in bulk; to be restricted in the use of certain antibiotics by having to consult with the microbiologist before ordering them?

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