Journal of evaluation in clinical practice
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The foundationalist and anti-foundationalist conceptions of medical knowledge have been at loggerheads for decades. Evidence-based medicine (EBM), the most prominent form of foundationalism, has attained wide appeal and acceptance among authorities. It proposes that evidence is the "base" upon which all clinical decisions should be grounded. ⋯ In this paper, I provide a survey of the foundationalist and anti-foundationalist debate in medicine and defend anti-foundationalism on the basis that foundationalist approaches are anachronistic, and in the case of evidence-based medicine ultimately confuses inputs (evidence) for consideration in making a judgement with outputs (conclusions). I further propose that virtue ethics is inseparable from anti-foundationalism and conclude that the current infatuation with EBM implies something rather troubling; that physicians cannot be trusted to utilize their extensive training and skills to make reasonable decisions in the best interests of their patients. If this is in fact true, it suggests a crisis in virtue amongst medical professionals.
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User participation is nowadays a desirable feature of social services work. The International Federation of Social Workers states that staff shall promote the participation of clients so as to "enable them to be empowered in all aspects of decisions and actions affecting their lives." The statement is codified in various national ethical codes; the Swedish Code of Conduct and Ethical Behaviour for Social Workers specifies that interventions shall build on client participation and common agreement. However, a 2012 Swedish governmental report noted that among 16 methods for user participation in the social services, psychiatry, and abuse and addiction care, only one, shared decision making (SDM), had been evaluated in randomized controlled trials (RCTs). ⋯ Social workers do have good reasons for choosing certain methods for user participation rather than others. These methods can be found by looking at specific justificatory reasons. The case for SDM is strengthened by its having been evaluated in RCTs and also because the SDM components harmonize with relevant components in the presented (Swedish) legislation.