Science, Ethics, and the Making of Clinical Decisions
Implications for Risk Factor Intervention
- Lachlan Forrow, MD;
- Steven A. Wartman, MD, PhD;
- Dan W. Brock, PhD
- From the Division of General Internal Medicine, Rhode Island Hospital and Brown University (Drs Forrow and Wartman), and the Department of Philosophy, Brown University (Dr Brock), Providence, RI. Dr Forrow is now with the Division of General Medicine and Primary Care, the Department of Medicine, Beth Israel Hospital and Harvard Medical School, Boston.
Abstract
Recent improvements in the clinical care of individual patients are rooted in advances in two distinct fields of modern medicine: biomedical research and clinical ethics. In this article, we review the differing roles of these two disciplines in guiding decision making for individual patients. Particular attention is placed on decisions involving risk factor intervention, using the common problem of mild hypertension as an illustration. Both the importance and the limitations for decision making of some recently published clinical trials are reviewed. Differences in interpretation of these trials are a source of major disputes about the proper threshold for medical intervention. The ethical aspects of treatment decisions are then reviewed, with particular emphasis on the doctrine of informed consent and on the role of patient participation in treatment decisions. Finally, new directions for clinical research are suggested that may yield a more complete scientific basis for treatment decisions and that may aid in fulfilling the ethical ideals that underlie the physician-patient relationship.
(JAMA 1988;259:3161-3167)
Footnotes
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Reprint requests to Division of General Internal Medicine, Rhode Island Hospital, Providence, RI 02902 (Dr Wartman).
