Authors
Mark R. Tonelli
University of Washington
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.
Keywords clinical judgement  evidence‐based medicine  casuistry  epistemology  medical decision making
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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.
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.

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