EBPs have improved delivery of healthcare services; however, this practice is faced with ethical challenges in its implementation.
Presence of Conflicts of Interest
Health practitioners many at times play dual and complementary roles in the development and implementation of specific EBPs on behalf of funders and local communities. Leadbeater et al (2018) supports that when a prevention scientist who acts in two capacities, both a program developer and an implementer of EBP accrues personal benefits in the scale-up process then s/he may encounter conflict of interest. This in turn undermines the autonomy of stakeholders involved in decision-making.
Violation of Patient’s Privacy and Confidentiality
There is uncertainty in complete protection of patient’s data and privacy as the practice involves a lot of research and data sharing among healthcare stakeholders. Moreover with advancements in technology, health institutions are leaning towards e-storage of patients’ data but majority of the population are sceptical about this approach. For instance, Mikal et al (2016) found that 60% of internet users (twitter) do not support the use of social media data for research especially when it is to deal with healthcare practices. Corporate entities and governments collect massive amounts of data by default (even when protected) for further analysis. This violates patients’ privacy.
EBP Promotes RCTs Instead of Patient-Centred Healthcare. The practice focuses mainly on the primary use of evidence obtained from random controlled tests (RCTs).This runs counter to patient-centred care that promotes specific-case knowledge. Leadbeater et al (2018) adds that the reliance on EBPs has concerns such as the evidence base for an intervention and circumstances to apply it. At times practitioners and patients lose the right of choice especially in cases where EBP has protocols to be followed in delivering healthcare. For example, a health practitioner is forced to apply a medical principle to a similar case, say malaria without the patient’s informed consent. This may lead to infringement of patient’s rights and human dignity and could result in litigation against a health institution.
Implementation of EBPs is more of a management-driven care. This has resulted in rigid working environment for practitioners as the practice downplays certain types of knowledge that are relevant to healthcare provision over time such as the use experience, intuition and nous. Implementation of EBP has worked best in tightly defined areas such as Pharmacology. It is ill-suited for more craft-like areas such as surgery and nursing where experience counts a great deal.
Leadbeater, B. J., Sandler, I., Dishion, T., Bradshaw, C. P., Dodge, K., Gottfredson, D…. Smith, E. P. (2018) Ethical Challenges in Promoting The Implementation of Preventive Interventions: Reports of the SPR Task Force. Prev Sci 19, 853-865. Retrieved from https://doi.org/10.1007/s11121-018-0912-7
Mikal, J., Hurst, S. & Conway, M. (2016). Ethical Issues in using Twitter for Population-level Depression Monitoring: a qualitative study. BMC Med Ethics 17. Retrieved from https://doi.org/10.1186/s12910-016-0105-5