Crane D
Milbank Mem Fund Q Health Soc. 1975 Winter;53(1):1-33.
A questionnaire survey shows that physicians in four medical specialties evaluate chronically and terminally ill patients not only in terms of the physiological aspects of illness but also in terms of the extent to which they are capable of interacting with others. A patient's potential capacity to perform his social roles depends upon his "salvageability," i;e., the likelihood that he will be able to resume his roles and the degree of irreversible physical or mental damage which indicates his capacity for resuming them. The priorities in terms of treatment are the following: (1) salvageable patients with physical damage; (2) salvageable patients with mental damage and unsalvageable patients with physical damage; (3) unsalvageable patients with mental damage. Within these catagories variables such as patient attitude, family attitude, age, and social class, which define the social environment of the patient, also influence the physician's decision to treat him. Studies of hospital records of cases in two of the specialties were consistent with they survey findings. The findings suggest that there is a disparity between the traditional ethic concerning the treatment of such patients and the actual behavior of many physicians. As a solution to the inconsistencies between ideal and actual behavior, the development of medical guidelines for the withdrawal of treatment with respect ot certain specifically defined conditions is recommended.
一项问卷调查显示，四个医学专业的医生对慢性病患者和绝症患者的评估不仅基于疾病的生理方面，还基于他们与他人互动的能力。患者履行其社会角色的潜在能力取决于他的“可挽救性”，即他恢复角色的可能性以及表明其恢复能力的不可逆转的身体或精神损害程度。治疗的优先顺序如下：（1）身体有损伤的可挽救患者；（2）精神有损伤的可挽救患者和身体有损伤的不可挽救患者；（3）精神有损伤的不可挽救患者。在这些类别中，诸如患者态度、家庭态度、年龄和社会阶层等定义患者社会环境的变量，也会影响医生对其进行治疗的决定。对其中两个专业的病例医院记录的研究与调查结果一致。研究结果表明，传统的此类患者治疗伦理与许多医生的实际行为之间存在差异。作为解决理想行为与实际行为之间不一致的方法，建议制定针对某些具体定义情况的治疗撤销医学指南。
