Why High-Risk, Non-Expected-Utility-Maximising Gambles Can Be Rational and Beneficial: the Case of HIV Cure Studies

Abstract

Participation in early-phase clinical trials for HIV cure interventions frequently involves adverse medical risk-benefit ratios, challenging the orthodox normative assumption that rational decision-makers must maximize expected utility. Under risk-weighted expected utility theory, risk-averse and risk-inclined preferences represent rational variations in how individuals aggregate potential outcomes, distinct from their utility valuations and probability assessments. Consequently, choosing a high-risk medical intervention with negative expected utility can be instrumentally rational and beneficial for an individual who is reasonably risk-inclined and prioritizes potential best-case outcomes. This undermines standard ethical models in clinical research that evaluate protocols against the single benchmark of a hypothetical “reasonable person.” Rather than restricting enrollment strictly to trials with positive expected utility, research ethics committees should permit studies that are justifiable under some reasonable risk profiles. Ethical oversight should focus on carefully eliciting each candidate’s genuine risk attitudes and health valuations during informed consent, ensuring subjects are neither paternalistically barred from gambles that serve their considered interests nor permitted to undergo risks incompatible with their personal thresholds for aversion. – AI-generated abstract.