Applying EBM epistemology and the GRADE system to address practitioners' disagreements in medical malpractice allegations during COVID‐19 pandemic

Abstract

AbstractRationaleThe GRADE system of clinical recommendations has deontic implications and can discriminate between mandatory, prohibited, and merely permitted medical decisions.Aims and ObjectivesThe recommendation categories of the GRADE framework map onto deontological imperatives that can lead to a better understanding and management of allegations of imprudence and appropriateness of treatments. Allegations made during the worst phase of COVID‐19 pandemic are used as a case study for exploring the deontic implications of GRADE.MethodConceptual theoretical analysis, case study analysis, and argumentation in defence of hypotheses.ResultsStrong GRADE recommendations for or against treatment are justified by high–quality evidence and can be construed as ethical obligations and prohibitions. In contrast, when evidence for benefit or harm is of lower quality, GRADE yields weak, discretionary recommendations. In such grey area cases, the absence of a duty to prescribe or refuse to prescribe a requested treatment is compatible with the privilege of considering unproven but possibly beneficial options in a private setting. This privilege, however, does not extend to healthcare policymakers, who have a duty to promote actions that serve the public and whose recommendations should not be guided by personal or idiosyncratic preferences or values.ConclusionIf there is no prima facie evidence that a proposed treatment is harmful, doctors are not negligent in considering it in shared doctor‐patient decision‐making. But these clinical decisions under uncertainty do not transfer obligations to health authorities, who are not part of the decision‐making process in clinical settings. The clinical decision‐making process concerns particulars and is guided by contextual and specific reasons that do not fall within the scope of a general policy. Thus, in the context of a serious epidemic in which patients need and demand treatments, if the body of evidence is still changing and fragile, an attitude of tolerance and connivance may ensure a smoother transition to a more stable phase of progress, both in scientific and clinical medicine.