Ethical Issues in Clinical Genetics and the Indian Subcontinent
The day-to-day practice of clinical genetics, and of medicine more widely, requires the making not only of scientific and technical judgements, but also of judgements of ‘value’. These may be explicit, such as when, for example, a doctor or nurse reflects on her own moral views about the permissibility of abortion. Often however, value judgements in medicine are implicit in what might appear at first glance to be ‘clinical’ decisions. Health professionals may not always think of themselves as making value judgements, for example, when considering what would be in an incompetent patient’s ‘best interests’; when weighing up whether harm to a third party is sufficiently ‘serious’ to justify a breach of patient confidentiality, or when assessing ‘quality of life’. Nevertheless, it is clear on reflection that these decisions do indeed involve the making of value judgements. Good health care practice requires that value judgements such as these are properly analysed and assessed, just as scientific and technical evidence should be properly evaluated and ‘evidence-based’. Health professionals must be prepared to justify their decisions both with regard to the scientific basis of the decision, and the ethical values by which it is guided. Evidence-based medicine requires interventions to be justified on the existence of evidence for the intervention’s effectiveness, and not on other grounds, such as that it is traditional practice, or on the authority of the clinician. It is increasingly recognised that a ‘value judgement’ has to be ‘evidence based’.
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