Should a doctor use a promising-but-unproven medicine, or handle it via a clinical trial?

Question

Suppose a patient has a life-threatening disease. The doctor can treat with a drug that sounds promising, but more data are needed before it's solidly proven to work. Alternatively, the doctor can use this opportunity as part of a clinical trial -- which could mean it takes longer, or maybe a different drug (or even placebo) is given ... but that will eventually establish firmer data for others.

How does halacha balance those?

(And would we distinguish between the current pandemic, in which arguably we'd assume thousands are choleh befanenu and society would be greatly improved by firmly-informed better treatments, vs. something like cancer?)

Answer 1

So after researching this subject more thoroughly, I came across this very comprehensive article here which quotes the above cited Rav Moshe but also brings other sources that say otherwise (hence the separate answer post). Again, it does not discuss the part of your question that asks about carrying out clinical trials but I would potentially argue that we have an obligation to save a life when we can at the first opportunity.

To quote the main headlines:

The author notes firstly the need to assess how much risk is involved and the resultant treatment.

The Mishnat Chachamim (cited in Teshuvot Achiezer 2:16:6) asserts that one is permitted to risk Chayei Shaah only if the risk to Chayei Shaah is fifty percent or less (Safek HaShakul). According to this view, one who is expected to live only for a short while is forbidden to engage in a medical procedure if there is a chance greater than fifty percent that the medical procedure might kill him immediately, even though there is a chance that the procedure might completely heal him. The Chatam Sofer (Teshuvot Y.D. 76, cited in the Pitchei Teshuva Y.D. 155:1) seems to agree with this ruling. Rav Chaim Ozer Grodzinsky (Teshuvot Achiezer ad. loc.), however, disagrees and permits a patient to assume an even greater risk than fifty percent in the hope to achieve a longer life.

This view of the Mishnas Chachomim is also supported by Rav Eliezer Waldenberg in his Teshuvos Tzitz Eliezer (10:25:5:5)

He then mentions the Rav Moshe cited above that one may take the risk but then writes however, that Rav Moshe wrote elsewhere in Igros Moshe, Yoreh Deah 3:36 that he is more inclined to the opinion of the Mishnas Chachamim, concluding that we cannot protest if one wishes to rely upon the ruling of Rav Chaim Ozer and assume a very great risk to Chayei Shaah.

Answer 2

I think what it boils down to is the sanctity of life, meaning although further testing would inevitably save many people in the long-term, if one person can be saved one is required to try and save him.

With that in mind perhaps the starting point is the gemara in Avoda Zara 27b that explores the notion of chayei sha'ah (lit. temporal life) where we say לחיי שעה לא חיישינן - i.e. We are permitted to risk a small amount of life if it will guarantee a refuah, or in other words, it is preferable to receive medical attention despite the risk involved.

Rav Moshe Feinstein zt"l famously brings a similar scenario in Igros Moshe, Yoreh Deah (cheilek 2) siman 58

He says that if the treatment/operation is a sofeik (a doubt) whether it is dangerous vs whether it will actually heal the person, but the patient will for sure die if they don't have the treatment - he would permit such a treatment even when the chances of survival are very slim. He brings Rav Henkin zt"l as a support for this conclusion.