Value conflicts in evidence-based practice

Abstract

Ethical dilemmas about care arise when the persons involved in care decisions have conflicting values. Evidence-based practice clarifies the nature of some ethical concerns about care because it sets three explicit values for clinical decision-making: effectiveness of care, efficiency of care, and incorporation of patient values. Defining effectiveness involves establishing relative values for outcomes and determining whose values must be considered. Defining efficiency involves establishing relative values for resources used and determining whose resources must be included. Incorporation of patient values involves balancing those values against the values of other members of society or the strength of the evidence supporting a clinical recommendation. An evidence-based practice perspective that focuses on identifying conflicting values about outcomes, resources, and patient input into decision-making may be helpful in defining, discussing and resolving ethical care dilemmas.