Ian Roberts and colleagues maintain that "consent rituals, [which] delay the start of a trial treatment such that the treatment effect could be reduced or obscured, [are] actually unethical."1 We agree that consent is in practice a "ritual", that is to say a legally fictitious procedure which is not really capable of doing what it is primarily supposed to do: respect the patient's autonomy.2 Needless to say, we also concur with Roberts and colleagues' view that the principle of saving lives ought to prevail over a travestied ritual. We share their call to assess informed consent procedures as part of evidence-based medicine. But we reject their implicit proposal-to dispose of the consent requirement in emergency research-fearing that is might be co-opted by commercial forces.
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