精神医療におけるevidence-based medicine(EBM)に関する倫理的一考察

抄録

Evidence-Based Medicine (EBM)can be defined as a procedure to evaluate objectively the clinical efficacy of treatment from the viewpoint of a statistical appropriateness. It can also illustrate guidelines for diagnosis and treatment, make the most sophisticated up to date system of medical applications shared by medical professionals beyond individual and cultural difference, and finally, aim at standardization of medicine. As an ethical viewpoint, EBM may be able to provide more positive and essential informed consent by showing better evidence of the treatment to patients. EBM also meets social needs by allocating medical resources effectively, for it can supply, from the very beginning, the most effective treatment. Even in clinical cases, in which the etiology or pathology is unknown, or symptomatology is too complex or multidimensional, EBM can give an active guideline for the treatment to physicians, concentrating only on the efficacy of clinical application, temporarily neglecting the etiological factors. As the only principle to justify medical intervention is the risk/profit ratio, it is extremely important to evaluate usefulness of treatment objectively before introducing the treatment method. Concerning this point, EBM can provide the foundation for medical ethics. Especially in psychiatry, because of difficulty in identifying etiological factors, EBM has a very important role in ethical consideration. However, on the other hand, the popularization of EBM could possibly offer various problems. We must take note of the easy use of EBM as a manual-book, overconfidence or misunderstanding of its "objectivity", neglecting the notion of "Comprehension" (Jaspers K) and related psychopathology, and alteration of patient-physician relationships evoked by a preponderance of objective data.