Mebane E W, Oman R F, Kroonen L T, Goldstein M K
The Permanente Medical Group, Inc., Redwood City, California, USA.
J Am Geriatr Soc. 1999 May;47(5):579-91. doi: 10.1111/j.1532-5415.1999.tb02573.x.
To determine whether physicians' preferences for end-of-life decision-making differ between blacks and whites in the same pattern as patient preferences, with blacks being more likely than whites to prefer life-prolonging treatments.
A mailed survey.
American Medical Association (AMA) and National Medical Association (NMA) databases. To enrich the sample of black physicians, we targeted physicians in the AMA database practicing in high minority area zip codes and graduates of the traditionally black medical schools.
Self-reported physician attitudes toward end-of-life decision-making and preference of treatment for themselves in persistent vegetative state or organic brain disease compared by race, controlling for age and gender.
The 502 physicians (28%) who returned the questionnaire included 280 white and 157 black physicians. With regard to attitudes toward patient care, 58% of white physicians agreed that tube-feeding in terminally ill patients is "heroic," but only 28 % of black physicians agreed with the statement (P < .001). White physicians were more likely than black physicians to find physician-assisted suicide an acceptable treatment alternative (36.6% vs 26.5% of black physicians) (P < .05). With regard to the physicians preferences for future treatment of themselves for the persistent vegetative state scenario, black physicians were more than six times more likely than white physicians to request aggressive treatments (cardiopulmonary resuscitation, mechanical ventilation, or artificial feeding) for themselves (15.4% vs 2.5%) (P < .001). White physicians were almost three times as likely to want physician-assisted suicide (29.3% vs 11.8%) (P < .001) in this scenario. For a state of brain damage with no terminal illness, the majority of all physicians did not want aggressive treatment, but black physicians were nearly five times more likely than white physicians (23.0% vs 5.0%) (P < .001) to request these treatments. White physicians, on the other hand, were more than twice as likely to request physician-assisted suicide (22.5% vs 9.9%), P < .001 in this scenario.
Physicians preferences for end-of-life treatment follow the same pattern by race as patient preferences, making it unlikely that low socioeconomic status or lack of familiarity with treatments account for the difference. Self-denoted race may be a surrogate marker for other, as yet undefined, factors. The full spectrum of treatment preferences should be considered in development of guidelines for end-of-life treatment in our diverse society.
确定医生在临终决策方面的偏好，黑人和白人之间是否存在与患者偏好相同的模式，即黑人比白人更倾向于选择延长生命的治疗方法。
邮寄调查。
美国医学协会（AMA）和全国医学协会（NMA）数据库。为了增加黑人医生的样本数量，我们将AMA数据库中在少数族裔聚居地区邮政编码区域执业的医生以及传统黑人医学院的毕业生作为目标对象。
按种族比较医生自我报告的对临终决策的态度以及在持续性植物状态或器质性脑疾病情况下对自身治疗的偏好，并对年龄和性别进行控制。
502名（28%）回复问卷的医生中，有280名白人医生和157名黑人医生。在对患者护理的态度方面，58%的白人医生认为对绝症患者进行鼻饲是“英勇行为”，但只有28%的黑人医生同意这一说法（P<.001）。白人医生比黑人医生更有可能认为医生协助自杀是一种可接受的治疗选择（36.6%对26.5%的黑人医生）（P<.05）。在持续性植物状态情况下，黑人医生为自己选择积极治疗（心肺复苏、机械通气或人工喂养）的可能性是白人医生的六倍多（15.4%对2.5%）（P<.001）。在这种情况下，白人医生希望医生协助自杀的可能性几乎是黑人医生的三倍（29.3%对11.8%）（P<.001）。对于无绝症的脑损伤状态，大多数医生都不希望进行积极治疗，但黑人医生要求这些治疗的可能性几乎是白人医生的五倍（23.0%对5.0%）（P<.001）。另一方面，在这种情况下，白人医生要求医生协助自杀的可能性是黑人医生的两倍多（22.5%对9.9%），P<.001。
医生在临终治疗方面的偏好按种族与患者偏好遵循相同模式，这使得社会经济地位低或对治疗不熟悉不太可能是造成差异的原因。自我表明的种族可能是其他尚未明确的因素的替代指标。在为我们多元社会制定临终治疗指南时，应考虑到所有治疗偏好。
