Worrall John
Department of Philosophy, Logic and Scientific Method, London School of Economics, Houghton Street, London, UK.
Perspect Biol Med. 2008 Summer;51(3):418-31. doi: 10.1353/pbm.0.0040.
Ethics and epistemology in medicine are more closely and more interestingly intertwined than is usually recognized. To explore this relationship, I present a case study, clinical trials of extracorporeal membrane oxygenation (ECMO; an intervention for persistent pulmonary hypertension of the newborn).Three separate ethical issues that arise from this case study-whether or not it is ethical to perform a certain trial at all, whether stopping rules for trials are ethically mandated, and the issue of informed consent-are all shown to be intimately related to epistemological judgments about the weight of evidence. Although ethical issues cannot, of course, be resolved by consideration of epistemological findings, I argue that no informed view of the ethical issues that are raised can be adopted without first taking an informed view of the evidential-epistemological ones.
医学中的伦理学与认识论之间的相互交织比通常所认识到的更为紧密且有趣。为探讨这种关系，我呈现一个案例研究，即体外膜肺氧合（ECMO；一种针对新生儿持续性肺动脉高压的干预措施）的临床试验。该案例研究引发了三个不同的伦理问题——进行某项试验本身是否合乎伦理、试验的终止规则是否在伦理上具有强制性以及知情同意问题——所有这些都表明与关于证据权重的认识论判断密切相关。当然，伦理问题不能通过考虑认识论研究结果来解决，但我认为，如果不首先对证据认识论问题有明智的看法，就无法对所提出的伦理问题形成明智的观点。
