> We consider it perfectly acceptable

I doubt people on an ethics board for medical studies would find that perfectly acceptable.

And I agree, but isn't that a strong indictment of medical ethics? If medical ethicists would rather let a fire burn out of control than risk the lives of firefighters to put it out, they're not optimizing for the right thing.

I don't see why it is a strong indictment of any sort of ethics. Waging war is wrong, and saying that it's perfectly acceptable to do so is entirely missing the point.

Firefighters are a separate issue altogether, because the subject being discussed is a lot more ambiguous than firefighting (where the problem is clear, and the consequence for sending a firefighter is a positive result).

The armed forces aren’t a randomized trial.

Many people go into harms way because of a necessary duty (firefighters, etc).

The restrictions on medical trials is because of the power imbalance. If I take a job as a firefighter or soldier that’s different from me living my life and being enrolled in some study putting me at risk for harm.

I don't see how volunteering to enroll in a study (and being compensated for it) is any different to choosing to take a job as a soldier or firefighter.

Taking a job as a soldier is not at all comparable to taking a job as a fire fighter.

Both are expected to expose themselves to risk, both get paid. The many differences seem irrelevant to the topic at hand. What am I missing?

Soldiers tend to kill people, firefighters tend to save people, the difference - to me - would seem to be obvious.

That difference still seems to me not relevant to the topic at hand.

A printer creates documents and a paper shredder destroys them. Therefore, we can't compare the amount of power they draw from an AC outlet.

Soldiers and firefighters also certainly skew less wealthy/educated/powerful, so a priori I'd say the same power dynamics apply there (though it's of course possible that the effect is smaller if you dig into the numbers).

It's also entirely possible that some people would feel driven to participate in a medical study out of a sense of duty (e.g. I'm young and healthy and want to put myself at a bit of risk to contribute to our understanding of the virus so that my much more vulnerable (grand)parents have a better chance).

Dangling significant financial incentives to the poor or otherwise disadvantaged is one of their big tricks, too.