How Can We Practice Ethical Medicine When the Evidence Is Always Changing?

Abstract

The practice of ethical medicine requires that the clinician offers interventions that are likely to help (beneficence), avoid interventions that are likely to harm (nonmaleficence), and allow for autonomous decision making. Our determination of what is in the best interest of the patient is dependent on the state of medical evidence at the time. However, as evidence evolves, the balance of beneficence and nonmaleficence may change, even to the extent of a complete reversal. In this article, I explore the issues of autonomy, particularly parental autonomy for a child, in a world in which the evidence is always changing.

Keywords: end-of-life care; ethics; evidenced based medicine; pediatrics; professionalism.