Current thinking in medical ethics posits that treatment decisions should result from negotiation between clinician and patient as autonomous agents. However the view of science that underlies most thinking about evidence in medicine encourages the belief that in principle optimal evi-dence-based judgment as to best treatments can be reached by the clinician apart from such ne-gotiation, reducing negotiation to a sham process. A model-based notion of science, derived from a naturalistic philosophy of science, argues that the process of predicting optimal treatment re-quires consideration of a patient’s goals, and thus requires ongoing negotiations with the patient. Hence values are integral to the scientific process, not something extra-scientific that must be reconciled with it. From this perspective the clinician’s activity becomes one with scientific method rather than an ill-defined, and typically undervalued, art.
Evidence in medicine: math versus biology!