Simulation As An Ethical Imperative And Epistemic Responsibility For The Implementation Of Medical Guidelines In Health Care

Keywords

Epistemic responsibility; Ethical imperative; Learning health systems; Medical guideline implementation; Medical simulation; Moral luck

Abstract

Guidelines orient best practices in medicine, yet, in health care, many real world constraints limit their optimal realization. Since guideline implementation problems are not systematically anticipated, they will be discovered only post facto, in a learning curve period, while the already implemented guideline is tweaked, debugged and adapted. This learning process comes with costs to human health and quality of life. Despite such predictable hazard, the study and modeling of medical guideline implementation is still seldom pursued. In this article we argue that to systematically identify, predict and prevent medical guideline implementation errors is both an epistemic responsibility and an ethical imperative in health care, in order to properly provide beneficence, minimize or avoid harm, show respect for persons, and administer justice. Furthermore, we suggest that implementation knowledge is best achieved technically by providing simulation modeling studies to anticipate the realization of medical guidelines, in multiple contexts, with system and scenario analysis, in its alignment with the emerging field of implementation science and in recognition of learning health systems. It follows from both claims that it is an ethical imperative and an epistemic responsibility to simulate medical guidelines in context to minimize (avoidable) harm in health care, before guideline implementation.

Publication Date

3-1-2017

Publication Title

Medicine, Health Care and Philosophy

Volume

20

Issue

1

Number of Pages

37-42

Document Type

Article

Personal Identifier

scopus

DOI Link

https://doi.org/10.1007/s11019-016-9719-0

Socpus ID

84982899735 (Scopus)

Source API URL

https://api.elsevier.com/content/abstract/scopus_id/84982899735

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