Evidence-based practice and the ethics of discretion

Abstract

• Summary: The purported purpose of literature in the helping professions is to contribute to helping clients. Most authors who prepare articles are employed in universities and colleges which claim to value the pursuit of truth. Yet the professional literature is rife with inflated claims of what ‘we know’ and ‘do not know’ as well as distortions of ideas and issues. Nowhere is this more obvious than in the steady misrepresentation of the process and philosophy of evidence-based practice (EBP). Authors have exercised their discretion to misinform rather than to inform readers about this new idea that is so compatible with social work values and obligations described in professional codes of ethics (for example, to involve clients as informed participants and to be competent) and so sensitive to practitioners’ need for tools that enable them to meet ethical obligations in a context of uncertainty and lack of resources when making life-affecting decisions. • Findings: Evidence-based practice was developed to help practitioners to deal with the inherent uncertainty of practice in an informed, accountable way, paying attention to the need to develop tools to enable this process, such as the Cochrane and Campbell data bases of systematic reviews related to specific clinical and policy questions as well as constraints such as dysfunctional organizational practices and lack of resources. The importance of considering the unique circumstances and characteristics of each client, including their values and expectations, as well as the limitations of published research (e.g. inflated claims of effectiveness and hiding of disliked alternative views) is highlighted. Decision-making is viewed as a complex process requiring individual tailoring of decisions on the part of practitioners as well as skeptical appraisal of claims in published research. This process and philosophy shares core values promoted by social work. The process and philosophy of evidence-based practice as described in original sources is not presented in the majority of publications in social work. This makes it impossible for readers to understand the original vision as well as recent developments in its application. Indeed, the five-step process involved in EBP described in original sources is typically not described, even in entire books on the subject. Given that new ideas may benefit clients, for example by enabling the honoring of ethical obligations and encouraging the development of tools that practitioners need to make informed (rather than misinformed or uninformed) decisions, this is a concerning lapse. Many authors have used their discretion to hide rather than to reveal this new idea and related developments, such as new ways to involve clients as informed participants. Reasons why are suggested, including the play of propaganda in the helping professions, the failure to read original sources, and a detachment from the needs of direct line staff and clients. • Applications: This article suggests ethical obligations in exercising discretion when choosing how to describe new ideas (e.g. accurately or in a distorted form). The importance of reading original (rather than secondary) sources is emphasized.