Evidence-Based Medicine (EBM)

EBM makes two assumptions (Gupta 2003). First, it assumes that by pursuing truth (in other words, true conclusions about medical interventions) we will discover the most effective means of achieving health. . . . Second, and more controversially, EBM assumes that only by pursuing EBM do we maximize the likelihood of arriving at the truth about the effectiveness of medical interventions. In other words, only by pursuing EBM can we arrive at the best means of achieving health. [para] Taken together, the moral value that we should pursue the most effective means of achieving health, and the epistemological assumption that EBM is the most effective means of achieving health, lead to an inescapable moral conclusion: we should practice EBM. . . . This moral obligation constitutes the bedrock of EBM’s ethical commitments – improved health through improved knowledge of the effectiveness of interventions, best achieved via EBM (Gupta, 280). . . . EBM’s approach to decision making gives researchers, first and foremost, the authority to define what constitutes improved health or decreased harm to health. It is researchers who typically choose the outcomes under investigation in medical research, and it is these outcomes that EBM seeks to achieve. This is not to say that deontological and virtue ethics commitments are dismissed; however, the central purpose of EBM practice is not to foster our virtues or enhance our actions or duties towards patients. If the practice of EBM did not improve health outcomes (consequences), there would not necessarily be the urgent imperative – as there currently is – to teach and learn it. [para] EBM is not only consequentialist, it also contains a commitment to utilitarianism. . . . EBM does take a broadly utilitarian ethical perspective, in that it focuses on maximizing good by maximizing particular health outcomes” (281). . . . But even though utility is defined as the satisfaction of patient preferences, this does not capture what is emphasized as good in EBM. If patient preferences were satisfied but EBM led to no improvement in health, or to even worse health (according to researchers or clinicians) then pre-EBM practice, the principle of EBM utility would not be satisfied” (282).