Evidence-based practice: the ethical dimension
What has come to be called evidence-based practice is an approach to the evaluation and application of research evidence to clinical practice that, while ultimately traceable back to Enlightenment understandings of the generation and testing of empirical knowledge and, more recently, to writings of the logical positivists and Karl Popper, has a relatively recent origin. While, as with most intellectual developments, it is difficult to identify a particular person who was the first to articulate the idea, most authors trace its inception to the work of the British epidemiologist, Archie Cochrane, who suggested (Cochrane, 1972) that because healthcare resources will always be limited, they should be used to deliver interventions and services that well-designed evaluations have shown to be effective. A group of epidemiologists, biostatisticians and experts in medical informatics at McMaster University restated these principles (EBM Working Group, 1992) in a way that formed the basis for subsequent developments. They named their approach Evidence-Based Medicine (EBM), though it has since come to be applied to a range of healthcare professions resulting in a slight change in terminology to Evidence-based Practice (EBP). Indeed, the influence of the concept has continued to expand beyond healthcare to the extent that the term Evidence-Based Policy Making (EBPM) is now being employed (e.g., Solesbury, 2001; Cartwright and Hardie, 2012). A recent example of this is the UK government’s decision to establish four centres that will ‘produce and disseminate research to local decisionmakers, supporting them in investing in services that deliver the best outcomes for citizens and value for money for taxpayers’ (Cabinet Office, 2013). This document opens with the statement: ‘Our world leading “What Works” approach will ensure evidence is at the heart of decision making.’ Although a number of acronyms have been used for this approach to evaluating evidence, I will use EBP here as it is more relevant in the context of this book.