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Does evidence‐based health care have room for the self?
Author(s) -
Thomas S. Joshua
Publication year - 2016
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12563
Subject(s) - allegation , grounded theory , empirical evidence , evidence based medicine , foundationalism , health care , epistemology , psychology , scientific evidence , medicine , qualitative research , sociology , social psychology , medline , law , political science , philosophy , social science
Abstract Evidence‐based health care (EBHC) has consistently been attacked by opponents for being perniciously reductive. Although these attacks are overwhelmingly framed as critiques of evidence‐based medicine, they standardly target the research wing of EBHC upon which evidence‐based medicine is dependent, and increasingly extend to adjacent health care disciplines, such as nursing. One of the most persistent forms this line of attack has taken is the allegation that EBHC, with its emphasis on the hierarchy of evidence, grounded in the use of randomized controlled trials, and the clinical guidelines developed on their basis, fails to recognize the patient as the complex self she is, treating her instead as merely a quantifiable, medical‐scientific object. By reducing the patient to certain quantifiable dimensions, the patient as self is allegedly ‘erased’. In short, the complaint is that an evidence‐based approach to health care has no room for the self. Contrary to this persistently held view, it is argued here that EBHC does have room for the self. Review of these critiques suggests they can be categorized into two groups: soft critiques and strong critiques. Soft critiques tend to take a more measured tone grounded in empirical concerns about the dangers of an evidence‐based approach to health care, whereas strong critiques tend to make sweeping claims grounded in theoretical commitments to anti‐foundationalist philosophical frameworks. While both soft and strong critiques ultimately fail to make the case that EBHC has no room for the self, the empirical concerns of soft critiques nevertheless present a challenge EBHC advocates would do well to take seriously and address.