Book contents
- Frontmatter
- Contents
- Preface
- Acknowledgments
- 1 Foundations and history of evidence-based practice
- 2 The research synthesis revolution
- 3 Evidence of evidence, and other conceptual challenges
- 4 Human subjects, the Internet, databases, and data mining
- 5 Evidence at the bedside
- 6 Public health policy, Uncertainty, and genetics
- 7 Ethics and evidence
- References
- Index
7 - Ethics and evidence
Published online by Cambridge University Press: 29 September 2009
- Frontmatter
- Contents
- Preface
- Acknowledgments
- 1 Foundations and history of evidence-based practice
- 2 The research synthesis revolution
- 3 Evidence of evidence, and other conceptual challenges
- 4 Human subjects, the Internet, databases, and data mining
- 5 Evidence at the bedside
- 6 Public health policy, Uncertainty, and genetics
- 7 Ethics and evidence
- References
- Index
Summary
We are informed about everything. We know nothing.
Saul Bellow (1977)Ethical issues raised by meta-analysis/systematic review/research synthesis constitute the threads that have run throughout the preceding chapters. In this chapter, the threads will be pulled together with the goal of identifying the obligations of clinicians firstly and then clinical investigators, research synthesizers, and review boards. The intersection of ethics and evidence is an instance of the problem of ethical decision making in contexts of scientific uncertainty. That said, an “ethical best practice” is proposed for dealing with the practical challenges raised by evidence-based medicine, showing that ethical practice is, in large part, scientifically sound practice.
Evidence-based practice and fallibility
We do research to try to find out how the world works. We can make an observation, conduct a test, perform an experiment. Then we note what happens. All research is outcomes research.
When we train a student or colleague how to do something, we appeal to history, to precedent, to what has worked, to what the books and sages say. All training is about following guidelines.
If the world were simpler, everything would fit together more tidily. Research would show us unambiguously whether a phenomenon existed, why a drug worked, if that glass of wine were a good idea in terms of cardiovascular health. And we'd get it right the first time – none of this back and forth, she-loves-me-she-loves-me-not biomedical research. But the world is not simple.
- Type
- Chapter
- Information
- Ethics and Evidence-Based MedicineFallibility and Responsibility in Clinical Science, pp. 129 - 140Publisher: Cambridge University PressPrint publication year: 2002
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