> I have been asked to develop material which helps workshop participants to
> think through the ethical issues in using evidence.
It could be useful to think about this in a structured way. For example, in
terms of some of the principles of ethical practice together with concrete
examples
Beneficence: Need/failure to use interventions that are cost-effective
(e.g. aspirin in secondary prevention of MI, thrombolysis in the elderly)
Non-maleficence: Using interventions that do more harm than good (e.g. O2
concentrations to high in premature infants, antiarrhythmic drugs, and,
currently, albumin instead of crystalloids for resuscitation)
Autonomy: need to have evidence-based patient information and be able to
use the techniques of EBHC like Likelihood ratios so that information is
applicable to the individual patient (e.g. treating HT by baseline level of
risk rather than absolute levels of BP). This information also needs to be
presented in a meaningful way (e.g. the UK communication cock-up over third
generation oral contraceptives and the increased risk of thrombo-embolic
events - this could have been presented as risk differences and NNH rather
than relative risk which over-stressed harm).
Also need to see that evidence is only one part of equation of
decision-making. Patient values also important (e.g. wthe work of Sharon
Strauss on methods to take patient values into the decision (e.g.
anticoagulation)).
Need to be open about areas of uncertainty and not present current opinion
as fact. Similar that absence of evidence is not evidence of absence (e.g.
mishandling of BSE crisis and false reassurance that it could not be
transmitted to humans when the evidence was just not available).
Well this will do for now... ;-)
Amanda
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