Abstract
This paper challenges the traditional assumption that descriptive and prescriptive sciences are essentially distinct by presenting a study on the implicit normativity of the production and presentation of biomedical scientific facts within evidence-based medicine. This interdisciplinary study serves as an illustration of the potential worth of the concept of implicit normativity for bioethics in general and for integrated empirical ethics research in particular. It demonstrates how both the production and presentation of scientific information in an evidence-based decision-support contain implicit presuppositions and values, which pre-structure the moral environment of the clinical process of decision-making. As a consequence, the evidence-based decision support did not only support the clinical decision-making process; it also transformed it in a morally significant way. This phenomenon undermines the assumption within much of the literature on patient autonomy that information disclosure is a conditional requirement before patient autonomy even starts; patient autonomy is already influenced during the production and presentation of information. These results imply an increased responsibility of those who produce and present evidence-based facts(i.e. scientists in general and physicians in particular). The insights of this study not only involve a different focus on both theory and practice of patient autonomy and informed consent, but they also call for a broader scope of morality than does traditional empirical research in bioethics. The concept of implicit normativity within integrated empirical ethics research calls for a strong cooperation between bioethicists and descriptive scientists, i.e., a cooperation that goes beyond the discipline-specific epistemic values and that takes place during all phases of the research process.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Agich, G.J. (1990) Reassessing autonomy in long-term care. Hastings Cent Rep 20(6), 12-17.
Agich, G.J. (1992) Fragments on autonomy [unpublished].
Agich, G.J. (1993) Autonomy and long-term care. New York/Oxford: Oxford University Press.
Akkersdijk, G.J.M. (2000) Infrarenal abdominal aortic aneurysm: aspects of screening. Thesis at University Leiden, Netherlands.
Bayles, M.D. (1984) Moral Theory and Application. Social Theory and Practice 10, 97-120.
Beauchamp, T.L., & Childress, J.F. (1994) Principles of biomedical ethics. 4 ed. Oxford: Oxford University Press.
Berg, M., et al. (2001) Guidelines for Appropriate Care: The Importance of Empirical Normative Analysis. Health Care Analysis 9, 77-99.
Bimbacher, D. (1999) Ethics and social science: which kind of co-operation? Ethical Theory and Moral Practice 2, 319-336.
Bleichrodt, H., et al. (2001) Making Descriptive Use of Prospect Theory to Improve the Prescriptive Use of Expected Utility. Management Science 47, 1498-1514.
Brody, B.A. (1993) Assessing empirical research in bioethics. Theoretical Medicine 14, 211-219.
Dickenson, D.L. (1999) Can Medical Criteria Settle Priority-Setting Debates? The Need for Ethical Analysis. Health Care Analysis 7, 131-137.
Frith, L. (1999) Priority Setting and Evidence Based Purchasing. Health Care Analysis 7, 139-151.
Goodyear-Smith, F., & Buetow, S. (2001) Power Issues in the Doctor-Patient Relationship. Health Care Analysis 9, 449-462.
Habermas, J. (1980) Theorie des kommunikativen Handelns. Frankfurt am Main: Suhrkamp.
Halpern, D.F., et al. (1989) Using statistical risk information to assess oral contraceptive safety. Applied Cognitive Psychology 3, 251-260.
Have, H.A.M.J., & Lelie, A. (1998) Medical ethics research between theory and practice. Theoretical Medicine and Bioethics 19, 263-276.
Heeger, R., & Willigenburg, Tv., editors. (1993) What is meant by “The turn to applied ethics”? Kampen: Kok Pharos Publishing House.
Hoffmaster, B. (1989) Philosophical ethics and practical ethics-never the twain shall meet. In: Hoffmaster, B, Freedman, B, Fraser, G, editors. Clinical ethics-theory and practice-. Clifton, New Jersey: Humana Press, pp. 201-230.
Hoffmaster, B. (1991) The theory and practice of applied ethics. Dialogue 30, 213-234.
Hope, T. (1995) Evidence based medicine and ethics. J Med Ethics 21(5), 259-260.
Hux, J.E., & Naylor, D.C. (1995) Communicating the Benefits of Chronic Preventive Therapy: Does the Format of Efficacy Data Determine Patients' Acceptance of Treatment? Medical Decision Making 15, 152-157.
Kievit, J., et al. (2002) Optimizing outcome in patients with abdominal aortic aneurysm; a Markov decision analysis on the impact of surgery and follow-up on mortality and life-expectancy. [Submitted].
Lelie, A. (1999) Ethiek en nefrologie: een empirisch-ethisch onderzoek [Ethics and nephrology: an empirical ethics study]. Thesis at Catholic University Nijmegen, Netherlands.
Lindemann Nelson, J. (2000) Moral teachings from unexpected quarters. Lessons for bioethics from the social sciences and managed care. Hastings Center Report 30(1), 12-17.
Manschot, H. (1992) Levenskunst of lijfsbehoud? Een humanistische kritiek op het beginsel van autonomie in de gezondheidszorg [Art of Living or Preservation of Life? An Humanitarian Critique on the Principle of Autonomy in Health Care]. Utrecht, Universiteit voor Humanistiek (Oration).
Manschot, H. (1994) Kwetsbare autonomie: Over afhankelijkheid en onafhankelijkheid in de ethiek van de zorg. [Vulnerable Autonomy. On Dependency and Independency in the Ethics of Care.]. In: Manschot, H, Verkerk, M, editors. Ethiek van de zorg: een discussie [The Ethics of Care: A Discussion]. Amsterdam: Boom, pp. 97-118.
Molewijk, A.C., et al. (2003) Empirical data and moral theory. A plea for integrated empirical ethics. [submitted].
Molewijk, A.C., et al. (2003) Ideals of patient autonomy in medical decision-making. [submitted].
Molewijk, A.C., et al. (2003) Patient autonomy between moral theory and empirical data: Methodological considerations regarding empirical ethics research. [submitted, revision].
Moody, H.R. (1992) From informed consent to negotiated consent. Ethics in an aging society. Baltimore/London: The John Hopkins university Press.
Musschenga, B., & Steen, Wvd. (1999) Empirie in de ethiek en empirische ethiek [Empirical data in ethics and empirical ethics]. Kennis & Methode: Tijdschrift voor Empirische Filosofie [Knowledge and Method: Journal for Empirical Philosophy] 1999–2:155-166.
Musschenga, A.W. (1999) Empirical science and ethical theory: The case of informed consent. In: Musschenga, A.W, Steen, Wvd, editors. Reasoning in ethics and law: The role of theory, principles and facts. Ashgate: Aldershot, pp. 183-203.
Pearlman, R.A., et al. (1993) Contributions of empirical research to medical ethics. Theoretical Medicine 14, 197-210.
Pellegrino, E.D. (1995) The limitation of empirical research in ethics. J Clin Ethics 6(2), 161-162.
Sanders, G.D., et al. (1999) Distributed decision support using a web-based interface: prevention of sudden cardiac death. Med Decis Making 19(2), 157-166.
Schermer, M. (2001) The different faces of autonomy. A study on patient autonomy in ethical theory and hospital practice. Thesis at University of Amsterdam. Netherlands.
Steyerberg, E.W., et al. (1995) Perioperative Mortality of Elective Abdominal Aortic Aneurysm Surgery. A Clinical Prediction Rule Based on Literature and Individual Patient Data. Archives of Internal Medicine 155, 1998-2004.
Stone, E.R., et al. (1994) Risk communication: Absolute versus relative expressions of low probability risks. Organizational Behavior and Human Decision Processes 60, 387-408.
Sugarman, J., & Sulmasy, D.P., editors. (2001) Methods in Medical Ethics. Washington D.C.: Georgetown University Press.
Timmermans, D.R.M., & Meulen, J.H.P. (1993) Beslissingsanalyse: het nut voor de medische praktijk; een bespreking van de eerste bijeenkomst van het Landelijk Forum Medische Besliskunde [Decision analysis: its usefulness for the medical practice; a review of the first meeting of the National Forum for Medical Decision Making). Nederlands Tijdschrift voor Geneeskunde [Netherlands Journal for Medicine] 137(n. 36):1816-1819.
Timmermans, D.R.M., et al. (2001) Improving the quality of surgeons' treatment decisions: a comparison of clinical decision making with a computerised evidence based decision analytical model. Qual Health Care 10(1), 4-9.
Timmermans, D.R.M., et al. (2003) Communicating individualized risk information to surgery patients: what is the best format and which risks should be given? [Submitted].
Tronto, J.C. (1993) Moral boundaries: A political argument for an ethic of care. New Rork/London: Routledge.
Tversky, A., & Kahneman, D. (1992) Advances in prospect theory: Cumulative representation of uncertainty. Journal of Risk and Uncertainty 5, 297-323.
Weaver, G.R., & Trevino, L.K. (1994) Normative and empirical business ethics: Separation, marriage of convenience, or marriage of necessity? Business Ethics Quarterly 4(2), 129-143.
Widdershoven, G. (2000) Ethiek in de kliniek. Hedendaagse benaderingen in de gezondheidsethiek [Ethics in the Clinic. Contemporary Approaches in Health Care Ethics]. Maastricht: Boom.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Molewijk, A.C., Stiggelbout, A.M., Otten, W. et al. Implicit Normativity in Evidence-Based Medicine: A Plea for Integrated Empirical Ethics Research. Health Care Analysis 11, 69–92 (2003). https://doi.org/10.1023/A:1025390030467
Issue Date:
DOI: https://doi.org/10.1023/A:1025390030467