Our Code of Ethics as a guide for
negotiating the realities of
evidence-informed practice
Eileen Gambrill
School of Social Welfare
120 Haviland Hall
University of California, Berkeley
Berkeley, CA 94720
Evidence-based practice: A University/Agency Partnership for California
Los Angeles, CA February 23, 2006
gambrill@berkeley.edu
Ethical Obligations
•
•
•
•
Beneficence
Nonmalfeasance
Self-determination (informed consent)
Justice (equitable distribution of scarce
resources)
Questions
• Are we helping? Who are we helping in what
ways? How can we find out?
• Are we harming? Who and in what ways? How
can we find out?
• Are decisions well reasoned and informed? Are
decisions based on practice related research?
• Are clients fully informed?
• Have we identified content and procedural
knowledge that contributes to success/harm
avoidance?
Evidence-informed practice
• A way to handle the uncertainty associated with
making decisions in an ethical manner (Chalmers,
2003).
• Involved consumers
– Those who make clinical decisions (clients, families,
and clinicians)
– Purchasers and providers making managerial decisions
– Those making policy decisions at all levels of
government
Ethical obligations of researchers
• To use research methods that critically test
questions addressed
• To accurately and clearly describe what was
done and to what effect
• To accurately describe well-argued
alternative views and related evidence
• To avoid inflated claims
Ethical obligations of
administrators
• To use resources wisely; equitable distribution
• To confront clashes between individual
preferences and population needs and make just
decisions
• To create an organizational culture that encourages
ethical decisions
Ethical obligations of administrators,
cont.
• Each agency should accurately describe each
service provided, including those purchased, using
the following (Gray, 2001):
– Services critically tested and found to do more
good than harm
– Services of unknown effects
– Services critically tested and found to do more
harm than good
– Services of unknown effect but in high quality
research program
Some key decisions
1. Whether and how to involve clients or
consumer group representatives:
– In conducting and reviewing research
(Consumer participation may enhance the
quality, relevance and influence of reviews)
– In deciding what services to provide
– In planning how to overcome application
barriers
Some key decisions, cont.
2. Whether to attend to the ethics of excuses
–
–
–
We were too busy
They told us to do it
Other people do it
3. Whether to address application barriers
• These include organizational barriers,
common cognitive biases (Gambrill, 2005),
and the burden of knowledge.
Some key decisions, cont.
4. Whether to arrange open communities of inquiry
including:
– There is a focus on critically testing claims; for
example critical appraisal of agency services is
encouraged
– Errors and mistakes are identified (as well as related
causes) and are viewed as learning opportunities to
improve services
– Propaganda strategies as minimized
– Knowledge is viewed as hypothetical/tentative
– There is an awareness that we are all equal in out vast
ignorance (Popper)