试论循证医学的哲学基础

本文在哲学认识论的框架内探讨循证医学的哲学基础。在相当长的历史时期中，医学实践主要遵循理性推理。随着医学研究方法学的进步与发展，纯粹基于理性的医学实践开始受到质疑。循证医学将研究证据置于决策的中心地位，因此其哲学基础是经验论。然而，循证医学并未将经验论与理性绝对对立起来，正如经验论并不完全否认理性的作用，当严谨的系统性观察经验缺如时，循证医学主张应基于理性思维进行推理，由此获得的知识也可用于决策。无论是基于严谨的系统性观察经验还是理性推理进行决策，其终极目的都应使患者从医疗实践中受益。

Philosophical Basis of Evidence-based Medicine

In this essay, we discussed the philosophical basis of evidence-based medicine regarding epistemology.Medical practice mainly has been following rational reasoning for a long period of time. However, developments of modern epidemiology call rational reasoning in medicine into question. Evidence-based medicine endorses the central role of research evidence in decision-making. Therefore, its philosophical basis should be empiricism rather than rationalism. As empiricism does not completely exclude rationality from knowledge, evidence-based medicine does not use research evidence as a "one-size-fits-all" approach and claims that decisions can be based on rationality knowledge when lacking empirical observations. No matter what philosophical basis of evidence-based medicine is, the ultimate goal should always be achieving the largest benefits for patients in medical practice.