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What sort of bioethical values are the evidence-based medicine and the GRADE approaches willing to deal with?
  1. Joseph Watine
  1. Correspondence to Dr Joseph Watine, Laboratoire de biologie polyvalente, Hôpital de la Chartreuse, 12200 Villefranche-de-Rouergue, France; joseph.watine{at}


The concept of evidence-based medicine (EBM) has been invented by physicians mostly from English Canada, mostly from McMaster University, Ontario, Canada. The term EBM first appeared in the biomedical literature in 1991 in an article written by a prominent member of this group—Gordon Guyatt from McMaster University. The inventors of EBM have also created the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group, which is a prominent international organisation whose main purpose is to develop evidence-based clinical practice guidelines (CPGs). CPGs that are based on the GRADE approach are becoming increasingly adopted worldwide, in particular by many professional or governmental organisations. This group of thinkers being thus identified, we have retrieved and read many of their publications in order to try and understand how they intend to incorporate bioethical values into their concept. The author of this little essay did also spend a few years on the internet as an active member of the GRADE group discussion list. The observations thus gathered suggest that although some of the inventors of EBM, at least Gordon Guyatt, wish to incorporate core principles of biomedical ethics into their concept (ie, non-malevolence, beneficence and maybe to a lesser extent respect for autonomy, and justice), some clarifications are still necessary in order to better understand how they intend to more explicitly incorporate bioethical values into their concept and, perhaps more importantly, into evidence-based CPGs.

  • Evidence-based medicine
  • clinical practice guidelines
  • bioethics
  • values
  • applied and professional ethics
  • history of health ethics/bioethics

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  • Competing interests Dr Joseph Watine is member of the working group ‘Clinical Practice Guidelines’ of the European Federation of Clinical Chemistry (EFCC), and chairman of the working group ‘Clinical Practice Guidelines and Evidence-Based Laboratory Medicine’ of the Société Française de Biologie Clinique.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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