Clinical OpinionArgument-based medical ethics: A formal tool for critically appraising the normative medical ethics literature
Section snippets
The scope of the medical ethics literature
Before turning to the presentation of this formal tool, it is important to distinguish descriptive from normative medical ethics; the proposed formal tool is designed to be applied to normative medical ethics. The literature of descriptive medical ethics uses empiric methods to obtain data that describe the actual ethical judgments, practices, and policies of physicians and health care organizations, of patients and their families, and of the larger society. In addition, these articles report
Argument-based normative ethics
The first step of argument-based normative ethics is analysis. This has 2 subparts: assembly of a reliable and comprehensive account of the facts of the matter; and identification and clarification of concepts that are relevant to the evaluation of the ethical implications of those facts. Argument-based normative ethical reasoning must be grounded in clinical reality if it aims to have clinical application and should use concepts that are articulated clearly.
The second step of argument-based
Unacceptable appeals in normative ethics
Some appeals are not acceptable in argument-based ethics (Table II). Sulmasy and Sugarman12 provide a useful account of these mistaken forms of reasoning in argument-based normative ethics.
First, historic facts by themselves do not justify normative conclusions. That something has been done or not done in the past (eg, abortion), even if commonly done or prohibited, does not justify by itself our continuing to do or to prohibit it now. Second, majority opinions do not entail normative opinions,
Formal assessment tool
The appraisal tool for the normative ethics literature is summarized in Table III. We have adapted this tool from a recent work on critical appraisal of the medical literature that reported the results of qualitative research.8., 9.
Does the article address a focused ethics question?
As in the literature of basic and clinical science, normative ethics articles in obstetrics and gynecology should have a clear, well-defined focus. This focus should be reflected in the title and be made explicit in the introductory section of the paper. There are a number of possible domains for the focus of normative ethics literature, which include theoretic issues (such as, whether the fetus is a patient or a person), clinical issues for a specific patient population (the treatment of
Are the arguments that support the results of the article valid?
This question concerns whether the results of the article (ie, the conclusions that it makes about what morality in medicine should be) are supported by high-quality ethical analysis and argument. Does the article meet the standards of argument-based ethics? The literature of normative ethics in obstetrics and gynecology, as in many other specialties, is now very large, which makes it highly unlikely that there is no previous relevant literature that must be considered. Relevant literature
What are the results?
The results of normative ethics are the conclusions of ethical analysis and argument. As emphasized, these should be stated clearly and easy to find in the article.
Will the results help me in clinical practice?
The results of normative ethics articles and books can be helpful in at least 3 ways: First, they may have important practical implications, especially if the article incorporates evidence to support the clinical usefulness of acting on the conclusions of the article. The quality of the empiric evidence that is cited should be assessed in the same way as evidence should be assessed in any medical or scientific article.3., 4., 5., 6., 7., 8., 9., 10., 11. The results for clinical practice,
Comment
Physicians who specialize in obstetrics and gynecology confront ethical challenges routinely, from the primary care setting to the critical care unit to the administration of health care organizations.1 There is voluminous normative medical ethics literature that has analyzed and argued for clinical guidance for this range of ethical challenges, which include those challenges that are associated with the latest scientific and technologic developments. Most obstetricians and gynecologists, like
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