Permitting patients to pay for participation in clinical trials: the advent of the P4 trial
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Updated: Mar 13, 2026

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
David Shaw1,2, Guido de Wert3, Wybo Dondorp3
1Department of Health, Ethics and Society, CAPHRI Research School, Maastricht University, Maastricht, The Netherlands. d.shaw@maastrichtuniversity.nl.
Abstract:
In this article we explore the ethical issues raised by permitting patients to pay for participation (P4) in clinical trials, and discuss whether there are any categorical objections to this practice. We address key considerations concerning payment for participation in trials, including patient autonomy, risk/benefit and justice, taking account of two previous critiques of the ethics of P4. We conclude that such trials could be ethical under certain strict conditions, but only if other potential sources of funding have first been explored or are unavailable.
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