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循证医学和 GRADE 方法愿意处理什么样的生物伦理价值观?

What sort of bioethical values are the evidence-based medicine and the GRADE approaches willing to deal with?

机构信息

Laboratoire de biologie polyvalente, Hôpital de la Chartreuse, 12200 Villefranche-de-Rouergue, France.

出版信息

J Med Ethics. 2011 Mar;37(3):184-6. doi: 10.1136/jme.2010.039735. Epub 2010 Dec 3.

DOI:10.1136/jme.2010.039735
PMID:21131610
Abstract

The concept of evidence-based medicine (EBM) has been invented by physicians mostly from English Canada, mostly from McMaster University, Ontario, Canada. The term EBM first appeared in the biomedical literature in 1991 in an article written by a prominent member of this group-Gordon Guyatt from McMaster University. The inventors of EBM have also created the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group, which is a prominent international organisation whose main purpose is to develop evidence-based clinical practice guidelines (CPGs). CPGs that are based on the GRADE approach are becoming increasingly adopted worldwide, in particular by many professional or governmental organisations. This group of thinkers being thus identified, we have retrieved and read many of their publications in order to try and understand how they intend to incorporate bioethical values into their concept. The author of this little essay did also spend a few years on the internet as an active member of the GRADE group discussion list. The observations thus gathered suggest that although some of the inventors of EBM, at least Gordon Guyatt, wish to incorporate core principles of biomedical ethics into their concept (ie, non-malevolence, beneficence and maybe to a lesser extent respect for autonomy, and justice), some clarifications are still necessary in order to better understand how they intend to more explicitly incorporate bioethical values into their concept and, perhaps more importantly, into evidence-based CPGs.

摘要

循证医学(EBM)的概念是由大多来自加拿大英语区、主要来自加拿大安大略省麦克马斯特大学的医生发明的。这个术语于 1991 年首次出现在生物医学文献中,是该团体的一位杰出成员——来自麦克马斯特大学的 Gordon Guyatt 撰写的一篇文章中提出的。EBM 的发明者还创建了推荐分级评估、制定与评价(GRADE)工作组,这是一个知名的国际组织,其主要目的是制定基于证据的临床实践指南(CPG)。基于 GRADE 方法的 CPG 在全球范围内越来越被采用,特别是被许多专业或政府组织采用。鉴于这群思想家的身份,我们检索并阅读了他们的许多出版物,试图了解他们打算如何将生物伦理价值观纳入他们的概念。本文作者还在互联网上花费了数年时间,作为 GRADE 小组讨论列表的积极成员。因此收集到的观察结果表明,尽管 EBM 的一些发明者,至少 Gordon Guyatt,希望将生物医学伦理的核心原则纳入他们的概念(即不恶意、善行,也许在较小程度上尊重自主权和正义),但仍需要进一步澄清,以便更好地理解他们打算如何更明确地将生物伦理价值观纳入他们的概念,也许更重要的是,纳入循证 CPG。

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