Indication Quality: Concepts and Ethical Implications

Abstract

In recent times - also due to new laws - a good "indication quality" has been called for. The aim of this paper is to contribute to the debate about "indication quality" by looking into the meaning of the term "indication" as well as the meaning of an adequate understanding of quality. Initially, a conceptual analysis is made of how indication is an integral part of the therapeutic decision-making process between physician and patient, in which, next to evidence-based elements, also normative elements are included (step 1). In the second part, 2 different types of quality are contrasted (step 2): an externally quantifiable, standardized quality (Q-quality) and a quality pertaining to the individual physician, based on professional ethical values and principles (T-quality). For good "indication quality" it is suggested that both types of quality are included. As for Q-Quality, quantitative measures with selected quality indicators are proposed. Regarding T-Quality, qualitative, discursive procedures are more appropriate. It is suggested that the term "indication quality" be used for the quality of the whole therapeutic decision-making process including the indication itself. The indication should be based on profession-specific values rather than on other contextual or "private" ethical foundations. The legal and societal preconditions should set positive impulses for both ways of understanding the term "quality".