title: Simulation as an ethical imperative and epistemic responsibility for the implementation of medical guidelines in health care.
abstract: Guidelines orient best practices in medicine, yet, in health care, many real world constraints limit their optimal realization. Since guideline implementation problems are not systematically anticipated, they will be discovered only post facto, in a learning curve period, while the already implemented guideline is tweaked, debugged and adapted. This learning process comes with costs to human health and quality of life. Despite such predictable hazard, the study and modeling of medical guideline implementation is still seldom pursued. In this article we argue that to systematically identify, predict and prevent medical guideline implementation errors is both an epistemic responsibility and an ethical imperative in health care, in order to properly provide beneficence, minimize or avoid harm, show respect for persons, and administer justice. Furthermore, we suggest that implementation knowledge is best achieved technically by providing simulation modeling studies to anticipate the realization of medical guidelines, in multiple contexts, with system and scenario analysis, in its alignment with the emerging field of implementation science and in recognition of learning health systems. It follows from both claims that it is an ethical imperative and an epistemic responsibility to simulate medical guidelines in context to minimize (avoidable) harm in health care, before guideline implementation.
authors: Departments of Philosophy (College of Arts and Humanities) and Medical Education (College of Medicine), University of Central Florida, 4000 Central Florida Blvd., Orlando, FL, 32816-1352, USA. luciana.garbayo@ucf.edu.|Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA, USA. luciana.garbayo@ucf.edu.
authors: Luciana
authors: http://orcid.org/0000-0003-1764-127X
authors: L
authors: Garbayo
authors: Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.|Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA, USA.
authors: James
authors: J
authors: Stahl
mesh_terms: D004992:Ethics, Medical; D019983:Guideline Adherence / Q000941:ethics*; D006801:Humans; D019359:Knowledge; D059032:Learning Curve; D009014:Morals; D017410:Practice Guidelines as Topic; D000066908:Simulation Training / Q000941:ethics; D012941:Social Responsibility
keywords: Epistemic responsibility; Ethical imperative; Learning health systems; Medical guideline implementation; Medical simulation; Moral luck