Ethical considerations of evidence-based practice.

During the past decade evidence-based practice has become increasingly influential in social work practice and education (Gilgun, 2005). The increasing influence is evidenced by the proliferation of articles and books about the subject (Chwalisz, 2003). Evidence-based practice has largely been accepted as a positive advancement in the profession (Fook, 2004; Gilgun, 2005). Its proponents contend that basing social work practice on research evidence is an important ethical mandate (Gibbs & Grambrill, 2002). Indeed, incorporating state-of-the-art knowledge and research has long been considered essential to good social work practice (Goldstein, 1990; NASW, 2000). It is perhaps because of this recognition that the potential ethical consequences of the evidence-based practice movement have too infrequently been explored. Science, and, by extension, evidence-based practice, hold elevated and privileged positions within modern societies and are commonly viewed as value free and accepted on face value. Yet, within any epistemology lies implicit values that silently guide those who adopt its approaches and methods. This is also true for social work movements, theories and perspectives; values are embedded deeply within each and have implications for what problems the profession pays attention to and how it responds to them. Embedded within the structure and core elements of evidence-based practice are implied organizing principles that can lead to the privileging of certain sets of values, knowledge, and actions over others. Webb (2001) has asserted that "the emerging panacea of evidence-based practice in social work has thus far developed without critical commentary" (p.15). The purpose of this commentary is to briefly illuminate these tendencies as a means of stimulating dialogue and debate within the profession. The aim of this article is not to disparage the evidence-based practice movement but to highlight some of the dilemmas that call for more careful exploration. PRIVILEGING KNOWLEDGE OVER VALUES Although the evidence-based practice movement does not ignore professional values, the importance of validated scientific evidence is the central aspect of the approach and may overshadow social work values. Although science has provided many valuable insights for social work, there is a risk of overreliance on knowledge. Gordon (1965) articulated this concern over 40 years ago when she asserted the following: "If knowledge is called on when a value is needed as a guide to action, the resulting action may be unpurposeful" (p. 365) That is, social workers may achieve their stated aims, but their stated aims may not be the most important and necessary to achieve. Social work practice may indeed lose its "depth" or conscience. At its core, social work is a profession predicated on ideology and values (Perlman, 1986). For instance, one of the ways in which the elevation of knowledge over values can affect social work is through the privileging of efficiency over autonomy. If outcome research becomes the most important factor guiding social work services provision, a focus on client empowerment and autonomy may become at risk. For instance, research may show a specific medication or treatment approach to be most effective, yet clients may wish to handle these problems in a manner that is more consonant with their personal values or strengths. For example, a Puerto Rican client living in Philadelphia may wish to seek the services of a healer before considering an evidence-based cognitive behavioral or pharmacological intervention for depression. Although evidence-based practice does not call for practitioners to ignore the wishes of clients, it is feared that the focus on outcomes research would lead practitioners to overzealously "pushing" certain approaches. How this may affect work with vulnerable and oppressed populations over time is still unknown. Evidence-based studies have not ascertained the degree to which the use of its practices affects client empowerment, freedom, or "emancipation," longitudinally (Fook, Ryan, & Hawkins, 1997). …