Trial By Accident

The discipline of bioethics offers a romanticized version of its own history, too often assuming that the principles enshrined in successive bioethics conventions (autonomy, consent and freedom of contract) serve as ready-made analytic tools for investigating power relations in the clinic. This paper argues that the politics of clinical trials and human medical experimentation would be better understood as a function of the complex practices of power pertaining to the 'accident'. The modern experimental method was born in the seventeenth century when scholars began looking for ways to derive universal truths about nature from the methodological reproduction of unexpected events or accidents. The clinical trial, which was elaborated in the mid-twentieth century, refined this method, by making it possible, for the first time, to reproduce and standardize unexpected clinical events on a mass, industrial scale. This paper argues that the clinical trial needs to be understood within the larger complex of Taylorist interventions seeking to regulate accidental movement in the workplace. This evolution of productive methods is in turn enmeshed in the shift from the private regulation of accidents (tort law) to the social administration of risk by the welfare state. When placed within this perspective, the specificity of the mid-to-late twentieth-century clinic as a scene of production emerges in all its complexity - for while the randomized clinical trial is organized by the same regulation of movement and accident imposed on the industrial workplace, the risks borne by the 'human subject' have never been included within the portfolio of social risks to be administrated and redistributed by the welfare state.