When Evidence Outruns Ethics: A Concept Note on Technical Validity, Ethical Legitimacy, and Asymmetric Power in Healthcare

Evidence-based medicine, health economic evaluation, and clinical guidelines have substantially improved consistency and transparency in healthcare decision-making. However, their growing authority has also introduced a less examined ethical risk: the tendency for technically valid evidence to be treated as ethically self-justifying. This concept note identifies a recurring pattern in which ethical judgement becomes compressed, proceduralised, or prematurely closed in contexts characterised by uncertainty, abstraction, and asymmetric power between decision-makers and patients. Drawing on perspectives from political philosophy (Rawls), comparative justice (Sen), health economics (Williams), and the doctrine of clinical equipoise, the note argues that technical validity and ethical legitimacy are distinct forms of justification that cannot be collapsed into one another. The purpose of this note is not to criticise individual clinicians or institutions, nor to challenge evidence-based medicine itself, but to name a systemic ethical risk that warrants reflection before it becomes further embedded in clinical, policy, and algorithmic decision-making systems.