Journal of Evaluation in Clinical Practice 12 (3):248-256 (2006)
Authors |
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Abstract |
Evidence-based medicine (EBM) has thus far failed to adequately account
for the appropriate incorporation of other potential warrants for medical
decision making into clinical practice. In particular, EBM has struggled with
the value and integration of other kinds of medical knowledge, such as
those derived from clinical experience or based on pathophysiologic rationale.
The general priority given to empirical evidence derived from clinical
research in all EBM approaches is not epistemically tenable. A casuistic
alternative to EBM approaches recognizes that five distinct topics, 1)
empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale,
4) patient goals and values, and 5) system features are potentially relevant
to any clinical decision. No single topic has a general priority over any other
and the relative importance of a topic will depend upon the circumstances
of the particular case. The skilled clinician must weigh these potentially conflicting
evidentiary and non-evidentiary warrants for action, employing
both practical and theoretical reasoning, in order to arrive at the best choice
for an individual patient.
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Keywords | clinical judgement evidence‐based medicine casuistry epistemology medical decision making |
Categories | (categorize this paper) |
DOI | 10.1111/j.1365-2753.2004.00551.x |
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References found in this work BETA
The Abuse of Casuistry: A History of Moral Reasoning.Kenneth W. Kemp - 1988 - Philosophy and Rhetoric 24 (1):76-80.
Developments in the Evidence‐Based Health Care Debate – 2004.A. Miles, J. E. Grey, A. Polychronis, N. Price & C. Melchiorri - 2004 - Journal of Evaluation in Clinical Practice 10 (2):129-142.
The Philosophical Limits of Evidence-Based Medicine.Mark Tonelli - 1998 - Academic Medicine 73:1234-1240.
Is There Life After Evidence‐Based Medicine?Massimo Porta - 2004 - Journal of Evaluation in Clinical Practice 10 (2):147-152.
A Science of Individuals: Medicine and Casuistry.Kathryn Montgomery Hunter - 1989 - Journal of Medicine and Philosophy 14 (2):193-212.
View all 6 references / Add more references
Citations of this work BETA
Against Interpretability: a Critical Examination of the Interpretability Problem in Machine Learning.Maya Krishnan - 2020 - Philosophy and Technology 33 (3):487-502.
Problems with Using Mechanisms to Solve the Problem of Extrapolation.Jeremy Howick, Paul Glasziou & Jeffrey K. Aronson - 2013 - Theoretical Medicine and Bioethics 34 (4):275-291.
The Importance of Values in Evidence-Based Medicine.Michael P. Kelly, Iona Heath, Jeremy Howick & Trisha Greenhalgh - 2015 - BMC Medical Ethics 16 (1):69.
Evidence‐Based Healthcare, Clinical Knowledge and the Rise of Personalised Medicine.Andrew Miles, Michael Loughlin & Andreas Polychronis - 2008 - Journal of Evaluation in Clinical Practice 14 (5):621-649.
Medicine and Evidence: Knowledge and Action in Clinical Practice.Andrew Miles, Michael Loughlin & Andreas Polychronis - 2007 - Journal of Evaluation in Clinical Practice 13 (4):481-503.
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