Marsh F H
Program in Medical, School of Medicine, University of Colorado Health Sciences Center, Denver 80262.
Theor Med. 1992 Sep;13(3):285-92. doi: 10.1007/BF00489205.
Increasing complexities facing physicians negotiating the bedside decision continue to fuel the debate over who is the appropriate party to offer ethics consults, should one be needed, during the decision-making process. Some very good arguments have been put forth on behalf of clinical ethicists as being the proper and best party to engage in ethics consultations. However, serious questions remain about the role of the clinical ethicist and his ability to provide the necessary level of objectivity called for in an ethics consult. I argue that the clinician's professional psyche, or mode of thinking as a professional, leaves him little room to maneuver as an objective and detached third party ethics consultant. Several factors are cited and discussed that greatly influence the analyses applied to a case problem by physicians. The most formidable of these factors are habits and the practice of defensive medicine. I conclude that clinical ethicists are less suited for the overall tasks required of an objective consultant in medical cases that appear to involve insurmountable ethical issues.
在床边决策过程中，医生面临的复杂性日益增加，这继续引发了关于在决策过程中（如果需要的话）谁是提供伦理咨询的合适人选的争论。有人代表临床伦理学家提出了一些非常有力的论据，认为他们是进行伦理咨询的合适且最佳人选。然而，关于临床伦理学家的角色以及他提供伦理咨询所需的客观程度的能力，仍然存在严重问题。我认为，临床医生的职业心理，即作为专业人员的思维模式，使他几乎没有空间作为客观、超脱的第三方伦理顾问行事。文中列举并讨论了几个极大影响医生对病例问题分析的因素。其中最难以克服的因素是习惯和防御性医疗行为。我的结论是，在看似涉及无法克服的伦理问题的医疗案例中，临床伦理学家不太适合担任客观顾问所需承担的全部任务。
