I suppose that we should always be wary when the facts about an ethical dispute seem clear cut.  I say this because it strikes me that the vast majority of clinical medical ethical conflicts I have observed or read descriptions of tend to come down to misunderstanding or a lack of shared information.  For this reason, my first inclination when coming across an emergent issue in bioethics is to try to determine a) which facts are in dispute and b) where miscommunication may have occurred.  In situations as diverse as end-of-life care for Great Aunt Tillie to concerns about a NICU’s policies on perinates thinking about these two aspects have gone far in my experience in resolving disputes.

Thus it was with increasing confusion that I looked at the ethical concerns surrounding the Surfactant Positive Airway Pressure and Pulse Oximetry Trial (SUPPORT).  Here it did not seem that there were either facts in dispute or miscommunication between those seeing the study in very different lights.  (This of course is not to say that there was no miscommunication in the study itself; indeed this miscommunication strikes at the heart of the critique of the study.)  We all see what the study was and how the consent forms were written.  What we do not seem to agree on is how important the failings of those consent forms are.  This is not a miscommunication, but a difference in weighting of ethical standards.