Kowalski Charles J, Hutchinson Raymond J, Mrdjenovich Adam J
University of Michigan, Ann Arbor, Michigan, USA
University of Michigan Medical School, Ann Arbor, Michigan, USA
J Med Philos. 2017 Feb;42(1):7-32. doi: 10.1093/jmp/jhw032.
The Belmont Report's distinction between research and the practice of accepted therapy has led various authors to suggest that these purportedly distinct activities should be governed by different ethical principles. We consider some of the ethical consequences of attempts to separate the two and conclude that separation fails along ontological, ethical, and epistemological dimensions. Clinical practice and clinical research, as with yin and yang, can be thought of as complementary forces interacting to form a dynamic system in which the whole exceeds the sum of its parts. Just as effective clinical practice cannot exist without clinical research, meaningful clinical research requires the context of clinical practice. We defend this thesis by triangulation, that is, by outlining how multiple investigators have reached this conclusion on the basis of varied theoretical and applied approaches. More confidence can be placed in a result if different methods/viewpoints have led to that result.
《贝尔蒙报告》对研究与公认治疗实践的区分，致使诸多作者提出，这些据称截然不同的活动应由不同的伦理原则来规范。我们考量了试图将二者分离所产生的一些伦理后果，并得出结论：这种分离在本体论、伦理学和认识论层面均告失败。临床实践与临床研究，犹如阴阳两极，可被视为相互作用以形成一个动态系统的互补力量，在此系统中，整体大于部分之和。正如没有临床研究就不可能有有效的临床实践一样，有意义的临床研究也需要临床实践的背景。我们通过三角互证法来捍卫这一论点，也就是说，通过概述多位研究者基于不同的理论和应用方法是如何得出这一结论的。如果不同的方法/观点都导向了同一个结果，那么我们就可以对该结果更有信心。
