Evidence-based medicine: A clinical governance tool for rationalising or rationing health care?

摘要

Purpose - The purpose of this article is to provide a viewpoint on a controversial aspect of evidence-based medicine (EBM) and its application to clinical decision making and healthcare policy. To draw attention to the potential for using EBM as a rationalising tool, as opposed to rationalising treatment options, and to discuss how legitimacy in the decision-making process may be secured. Design/methodology/approach - A range of academic commentary and case law is reviewed. A model for the legitimacy of due process is suggested through the application of the framework for the "accountability for reasonableness". Findings - Provides information about sources indicating their relevance and where they can be found. Emphasises that NHS organisations and trusts need to enhance the legitimacy of due process through clinical governance. Research limitations/implications - Presents a viewpoint designed to stimulate debate, which is based on a critical evaluation of the literature as well as contemporary quality initiative issues in the context of clinical governance. Practical implications - A useful source of guidance for NHS Trust decision makers, healthcare practitioners and those involved with patient support initiatives. Originality/value - This paper provides an original viewpoint on a topical and important issue and develops the concept of legitimacy and decision making that is delivered by the application of legal principles through clinical governance.