The AZT studies raised ethical questions because the trial design could withhold a potentially beneficial treatment from participants. Which statement best captures this critique?

• A. The design fully prioritized participant welfare.
• B. The placebo group received superior treatment.
• C. The design did not adequately prioritize welfare by withholding treatment.
• D. Participants were not at risk.

Answer: (C)

Withholding a potentially beneficial treatment in a trial raises a welfare concern, because ethics in clinical research emphasize protecting participants from unnecessary harm while learning what works. If AZT could plausibly help, keeping some participants on a placebo or without access to the drug may deny them effective therapy and expose them to avoidable risk. This taps into beneficence and respect for persons—the obligation to maximize potential benefits and minimize harms for those enrolled. Researchers justify placebo use only when there is genuine uncertainty about which approach is better (equipoise) and when the design is necessary to determine efficacy. But the ethical critique centers on whether withholding treatment adequately protects participants’ welfare. The statement that best captures this is that the design did not adequately prioritize welfare by withholding treatment. The other options misrepresent the situation: the design wasn’t seen as fully prioritizing welfare, the placebo group did not receive superior treatment, and participants were indeed at risk.