Evidence and ethics in medicine.
Ethics and epistemology in medicine are more closely and more interestingly intertwined than is usually recognized. To explore this relationship, I present a case study, clinical trials of extracorporeal membrane oxygenation (ECMO; an intervention for persistent pulmonary hypertension of the newborn).Three separate ethical issues that arise from this case study-whether or not it is ethical to perform a certain trial at all, whether stopping rules for trials are ethically mandated, and the issue of informed consent-are all shown to be intimately related to epistemological judgments about the weight of evidence. Although ethical issues cannot, of course, be resolved by consideration of epistemological findings, I argue that no informed view of the ethical issues that are raised can be adopted without first taking an informed view of the evidential-epistemological ones.
Worrall
John
J
Department of Philosophy, Logic and Scientific Method, London School of Economics, Houghton Street, London, UK. j.worrall@lse.ac.uk
D026688:Bioethical Issues; D004992:Ethics, Medical; D019317:Evidence-Based Medicine / Q000941:ethics*; D015199:Extracorporeal Membrane Oxygenation / Q000941:ethics*; D006801:Humans; D007231:Infant, Newborn; D007258:Informed Consent / Q000941:ethics; D019359:Knowledge; D010547:Persistent Fetal Circulation Syndrome / Q000628:therapy*; D010686:Philosophy, Medical; D016032:Randomized Controlled Trials as Topic / Q000941:ethics; D016079:Refusal to Treat / Q000941:ethics