PubMed · 8644200
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R M Merion. 1996. How informed is informed consent?. https://pubmed.ncbi.nlm.nih.gov/8644200/
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This article explores the relation between the precautionary and health care decision making. Decision making in medical practice as well as health policy is characterized by uncertainty. On the level of clinical practice for example, one never knows in advance whether one has made the right diagnosis or has opted for the right treatment. Though medical decisions have a risk on serious harms and burdens, the precautionary principle is not applicable to health care. This principle holds that one should not act when there is no scientific proof that no harms will result from a medical act or a policy decision. However, in clinical practice there is a duty to act. Physicians have an obligation to do good to their patients and have to weigh the benefits against possible harms and burdens. The basis virtue of medical decision making is not avoidance of risks, as stated in the precautionary principle, but the prudent assessment of benefits, burdens, and harms, in relation to other ethical principles like respect for autonomy and justice. The precautionary principle does play a role in health care, but it should never rule medical decision making as an absolute principle. This is not only true for clinical decision making, but also for the area of health policy. Physicians and other health care decision makers need to have knowledge about the possible effects of treatments or the precision of diagnostic procedures in order to reduce harm and promote well-being. Evidence-based medicine may contribute to the wisdom of health care decision makers, but this evidence-based wisdom should always be applied under the guidance of prudence, which is the central virtue of health care decision making.
The Hippocratic oath derives its name from the ancient Greek physician Hippocrates. It has been embraced as a code of conduct by the medical profession throughout the ages, and is used by medical faculties as an explicit moment of reflection during graduation ceremonies. Although this oath is primarily of ceremonial value, it was felt that the text needed revision as it no longer reflected the current ethical norms in the Netherlands. The new Dutch oath drawn up in 2003 has a dual function: it is symbolic in that it represents the end of a doctor's training, but it is also intended to trigger the discussion of moral issues during the medical studies.
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