Molewijk A C, Stiggelbout A M, Otten W, Dupuis H M, Kievit J
Department of Medical Decision Making (1087), Leiden University Medical Center (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Health Care Anal. 2003 Mar;11(1):69-92. doi: 10.1023/A:1025390030467.
This paper challenges the traditional assumption that descriptive and prescriptive sciences are essentially distinct by presenting a study on the implicit normativity of the production and presentation of biomedical scientific facts within evidence-based medicine. This interdisciplinary study serves as an illustration of the potential worth of the concept of implicit normativity for bioethics in general and for integrated empirical ethics research in particular. It demonstrates how both the production and presentation of scientific information in an evidence-based decision-support contain implicit presuppositions and values, which prestructure the moral environment of the clinical process of decision-making. As a consequence, the evidence-based decision support did not only support the clinical decision-making process; it also transformed it in a morally significant way. This phenomenon undermines the assumption within much of the literature on patient autonomy that information disclosure is a conditional requirement before patient autonomy even starts; patient autonomy is already influenced during the production and presentation of information. These results imply an increased responsibility of those who produce and present evidence-based facts (i.e. scientists in general and physicians in particular). The insights of this study not only involve a different focus on both theory and practice of patient autonomy and informed consent, but they also call for a broader scope of morality than does traditional empirical research in bioethics. The concept of implicit normativity within integrated empirical ethics research calls for strong cooperation between bioethicists and descriptive scientists, i.e., a cooperation that goes beyond the discipline-specific epistemic values and that takes place during all phases of the research process.
本文通过对循证医学中生物医学科学事实的产生与呈现的隐含规范性进行研究，对描述性科学与规范性科学本质上截然不同这一传统假设提出了挑战。这项跨学科研究例证了隐含规范性概念对一般生物伦理学，尤其是对综合实证伦理学研究的潜在价值。它展示了循证决策支持中科学信息的产生与呈现都包含隐含的预设和价值观，这些预设和价值观预先构建了临床决策过程的道德环境。因此，循证决策支持不仅支持临床决策过程；它还以一种具有道德意义的方式对其进行了改变。这种现象削弱了许多关于患者自主性的文献中的假设，即信息披露是患者自主性开始之前的一个条件性要求；在信息的产生和呈现过程中，患者自主性就已经受到影响。这些结果意味着那些产生和呈现循证事实的人（即一般的科学家，尤其是医生）的责任增加了。这项研究的见解不仅涉及对患者自主性和知情同意的理论与实践的不同关注，而且它们还要求比传统生物伦理学实证研究更广泛的道德范畴。综合实证伦理学研究中的隐含规范性概念要求生物伦理学家与描述性科学家之间进行强有力的合作，即一种超越学科特定认知价值观且在研究过程的所有阶段都要进行的合作。
