From evidence-based care to the standard of care. Commentary on Kerridge (2009) Ethics and EBM: acknowledging difference, accepting difference, and embracing politics.

摘要

In his paper, 'Ethics and EBM: acknowledging difference, accepting difference, and embracing polities', Ian Kerridge provides an overview of the evolution of the meaning of evidence-based medicine (EBM) pointing out two central conceptual problems for its developers. First, the basic description of evidence-based practice, '... the integration of best research evidence with our clinical expertise and our patient's unique values and circumstances' never explains what constitutes 'integration', leaving open the question of what does and does not count as EBM [1]. Second, in an attempt to address criticisms, EBM has tried to expand the allowable inputs to clinical decision making, specifically by incorporating non-research-derived sources of knowledge (such as clinical expertise and patients' values). This move seems to render it more inclusive, while at the same time enables proponents to dismiss those who criticize its narrowness as misunderstanding EBM. However, Kerridge argues that this apparent inclusiveness implies, erroneously, that different sources of knowledge are directly comparable and can be hierarchically arranged in terms of their relative value for clinical decision-making.