Tuesday, November 4, 2008

Moral imperative of EOL research (?)

Journal of Medical Ethics has a wonkish (in the way a lot of ethics articles can be) discussion of the 'moral imperative' of end of life/palliative care research.  It's mostly a vigorous discussion of the ethical permissibility of studying people at the end of life, as well as its well-established acceptibility to patients and families.  One slightly strange aspect of it is that the author more or less describes non-evidence based/empiric-therapies as morally equivalent to N-of-1 research studies and suggests this is problematic because patients are essentially being experimented upon without their knowledge.  While I'm all for improving the evidence base and moving away from empiric therapies whenever possible, this analysis seems a little extreme, and just because I don't know which oral anti-emetic is most efficacious/tolerable in advanced cancer patients with non-specific chronic nausea as there have not been well-designed trials looking at that, that doesn't mean, per se, I'm 'experimenting' on someone when I prescribe them metoclopramide or haloperidol.  We can celebrate the randomized controlled trial without completely discounting other forms of knowledge (including the empiric wisdom of decades of experience)!

Pallimed | Blogger Template adapted from Mash2 by Bloggermint