King’s College London – Centre of Medical Law and Ethics, Strand London WC2R 2LS, UK.
Bioethics. 2012 Jul;26(6):315-28. doi: 10.1111/j.1467-8519.2011.01858.x. Epub 2011 Apr 27.
There are many ethical decisions in the practice of health research and care, and in the creation of policy and guidelines. We argue that those charged with making such decisions need a new genre of review. The new genre is an application of the systematic review, which was developed over decades to inform medical decision-makers about what the totality of studies that investigate links between smoking and cancer, for example, implies about whether smoking causes cancer. We argue that there is a need for similarly inclusive and rigorous reviews of reason-based bioethics, which uses reasoning to address ethical questions. After presenting a brief history of the systematic review, we reject the only existing model for writing a systematic review of reason-based bioethics, which holds that such a review should address an ethical question. We argue that such a systematic review may mislead decision-makers when a literature is incomplete, or when there are mutually incompatible but individually reasonable answers to the ethical question. Furthermore, such a review can be written without identifying all the reasons given when the ethical questions are discussed, their alleged implications for the ethical question, and the attitudes taken to the reasons. The reviews we propose address instead the empirical question of which reasons have been given when addressing a specified ethical question, and present such detailed information on the reasons. We argue that this information is likely to improve decision-making, both directly and indirectly, and also the academic literature. We explain the limitations of our alternative model for systematic reviews.
在健康研究和护理实践中，以及在政策和指南的制定中，存在着许多伦理决策。我们认为，那些负责做出此类决策的人需要一种新的审查类型。这种新的类型是系统综述的应用，系统综述经过几十年的发展，为医疗决策者提供了关于研究吸烟与癌症之间关系的所有研究结果意味着什么的信息，例如，吸烟是否会导致癌症。我们认为，有必要对基于理由的生物伦理学进行类似的包容性和严格性的审查，这种方法使用推理来解决伦理问题。在介绍了系统综述的简要历史之后，我们拒绝了现有的唯一一种基于理由的生物伦理学系统综述的写作模式，该模式认为，这样的综述应该解决一个伦理问题。我们认为，当文献不完整时，或者当伦理问题有相互矛盾但各自合理的答案时，这样的系统综述可能会误导决策者。此外，在讨论伦理问题时，如果没有确定所有给出的理由、它们对伦理问题的所谓影响以及对这些理由的态度，这样的综述也可以编写。我们提出的综述则针对在解决特定伦理问题时已经提出的理由这一经验问题，并提供了有关这些理由的详细信息。我们认为，这些信息可能会直接和间接地改善决策，并丰富学术文献。我们解释了我们对系统综述替代模型的局限性。
