[Four levels of value judgments in the medical outcome assessment--a systematic approach to the analysis of implicit normativity in evidence based medicine].
Systematic reviews and effectiveness analyses in the context of evidence-based medicine are not free of personal or group related values and interests. Effectiveness analysis has to deal with various "value judgments" concerning questions like 'what are relevant study endpoints and adequate methodologies for context-related data analysis?' or 'which deviation from the desirable und feasible methodology in clinical research is still acceptable?' Value judgments regarding these questions have a considerable influence on the process of effectiveness analysis and the presentation of its results. A sound and responsible approach to the necessary projects of evidence-based medicine requires a methodology for identifying their implicit normativity and making it more explicit. This article presents a checklist for the identification of central value judgments in effectiveness analyses and describes their role within the ethics of evidence-based medicine. Furthermore, the need for a broader concept of transparency--as a consequence of the implicit value judgments--will be discussed.
Strech
Daniel
D
Institut für Ethik und Geschichte der Medizin, Eberhard-Karls-Universitat Tübingen, Schleichstrasse 8, 72076 Tübingen. daniel.strech@uni-tuebingen.de
D004992:Ethics, Medical; D019317:Evidence-Based Medicine / Q000592:standards*; D005858:Germany; D006801:Humans; D007600:Judgment; D017063:Outcome Assessment, Health Care / Q000592:standards*; D016896:Treatment Outcome