Dickenson Donna, Vineis Paolo
University of Birmingham, UK.
Health Care Anal. 2002;10(3):243-59. doi: 10.1023/A:1022995623172.
In this paper we set out to examine the arguments for and against the claim that Evidence-Based Medicine (EBM) will improve the quality of care. In particular, we examine the following issues: 1. Are there hidden ethical assumptions in the methodology of EBM? 2. Is there a tension between the duty of care and EBM? 3. How can patient preferences be incorporated into quality guidelines and effectiveness studies? 4. Is there a tension between the quality of a particular intervention and overall quality of care? 5. Are certain branches of medicine and patient groups innately or prima facie disadvantaged by a shift to EBM? In addition we consider a case study in the ethics of EBM, on a clinical trial concerning the collection of umbilical cord blood in utero and ex utero, during or after labour in childbirth.
在本文中，我们着手探讨支持和反对循证医学（EBM）将提高医疗质量这一观点的论据。具体而言，我们将研究以下问题：1. 循证医学方法中是否存在隐藏的伦理假设？2. 医疗责任与循证医学之间是否存在冲突？3. 如何将患者偏好纳入质量指南和疗效研究？4. 特定干预措施的质量与整体医疗质量之间是否存在冲突？5. 转向循证医学是否会使某些医学分支和患者群体天生或表面上处于不利地位？此外，我们还考虑了一个循证医学伦理学的案例研究，该研究涉及一项关于分娩过程中或分娩后子宫内和子宫外脐带血采集的临床试验。
