广泛的医学不确定性与公开的道德义务。
Broad Medical Uncertainty and the ethical obligation for openness.
作者信息
Brown Rebecca C H, de Barra Mícheál, Earp Brian D
机构信息
Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
Centre for Culture and Evolution, Brunel University London, London, UK.
出版信息
Synthese. 2022;200(2):121. doi: 10.1007/s11229-022-03666-2. Epub 2022 Apr 10.
This paper argues that there exists a collective epistemic state of 'Broad Medical Uncertainty' (BMU) regarding the effectiveness of many medical interventions. We outline the features of BMU, and describe some of the main contributing factors. These include flaws in medical research methodologies, bias in publication practices, financial and other conflicts of interest, and features of how evidence is translated into practice. These result in a significant degree of uncertainty regarding the effectiveness of many medical treatments and unduly optimistic beliefs about the benefit/harm profiles of such treatments. We argue for an ethical presumption in favour of openness regarding BMU as part of a 'Corrective Response'. We then consider some objections to this position (the 'Anti-Corrective Response'), including concerns that public honesty about flaws in medical research could undermine trust in healthcare institutions. We suggest that, as it stands, the Anti-Corrective Response is unconvincing.
本文认为，对于许多医学干预措施的有效性，存在一种“广义医学不确定性”（BMU）的集体认知状态。我们概述了BMU的特征，并描述了一些主要促成因素。这些因素包括医学研究方法的缺陷、出版实践中的偏见、财务和其他利益冲突，以及证据转化为实践的方式。这些因素导致了许多医学治疗有效性的高度不确定性，以及对这些治疗的利弊情况过度乐观的看法。我们主张作为“纠正性回应”的一部分，在伦理上假定支持对BMU保持开放态度。然后我们考虑了对这一立场的一些反对意见（“反纠正性回应”），包括担心公开医学研究中的缺陷会削弱对医疗机构的信任。我们认为，就目前情况而言，反纠正性回应并不令人信服。
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