Ethics and Evidence Based Practice: Articulating Their Relationship

This round table discussion's aims are to respectfully investigate the philosophical underpinnings of EBP and to advance dialogue on the important calls for social work to be evidence based.Evidence based practice (EBP) in social work is rooted in evidenced-based medicine (EBM). Upshur (2005), physician-philosopher, notes EBM is “one of the most influential doctrines in the medical world” (447). The Evidenced Based Medicine Working Group, McMaster University, that included David Sackett, one of the early advocates of EBM, published a seminal article in JAMA extolling a new “paradigm” that “de-emphasises intuition, unsystematic clinical experience” and instead stresses “evidence from clinical research” (1992, p. 2420). Recently, clinical experience, patients' values and preferences have been stressed; Sackett et al. (2000) wrote that “the integration of best research evidence with clinical expertise and [client] values” (p. 1) is at the heart of EBM. Jenson & Howard (2008) describe EBP in social work thusly: “[A]n educational and practice paradigm that includes a series of predetermined steps aimed at helping practitioners and agency administrators identify, select, and implement efficacious interventions for clients.” Evident is the synchrony with Sackett et al.'s EBM-terminology; “EBP seeks to systematically integrate evidence about the efficacy of interventions in clinical decision-making” (Jenson & Howard, 2008). EBP in social work is promoted as a philosophy and an approach to practice (Jenson & Howard, 2008). However, the full philosophical/ethical implications of EBP have not been fully investigated. Evaluating EBP from a philosophical point of view leads to a paradox, because “if you hold that information about the world can only be obtained by observation and experiment, philosophers, who neither observe nor experiment, will inevitably seem peculiarly ill fitted to get it” (Harrison, 2004, p. 14). Nonetheless, given that social work rests on values and ethics, EBP must meet the rigors of the ethical core and demands of the profession. This roundtable will examine the following pertinent questions: Can an ethical assessment of the merits of EBP be encompassed within the tenets of EBP? What sort of philosophical and ethical argument* on the merits of EBP can pass muster using the directives of EBP? Or does the profession's ethical code precede and provide the rationale for EBP? [*Presenter will provide overview of prominent ethical schools of thought (teleological, ethics of care etc.). Concepts of 'do no harm' and fiduciary relationship that relate to the promotion of EBP will be included. She will facilitate discussion.] Is the reasoning of the helping professions “considered hermeneutic” (Upshur, 1999, p. 326)? Horton (cited in Upshur, 2005) perceptively observes, research evidence “provides at best a provisional warrant—that is, drug X may work, not drug X will work” (p. 483). Research evidence is not ‘directive'. To what extent does EBM inform the clinician how to make logical and interpretative inferences from averages to the individual client? What are the results of the lone practitioner--equipped with a few semesters' worth of research and statistics (Wakefield & Kirk, 1996)--in an agency setting? How do we soundly and ethically judge his/her efforts?