Lyerly Anne Drapkin, Mitchell Lisa M, Armstrong Elizabeth M, Harris Lisa H, Kukla Rebecca, Kuppermann Miriam, Little Margaret Olivia
Department of Obstetrics and Gynecology and Trent Center for Bioethics, Humanities, and History of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Obstet Gynecol. 2007 Apr;109(4):979-84. doi: 10.1097/01.AOG.0000258285.43499.4b.
Assessing, communicating, and managing risk are among the most challenging tasks in the practice of medicine and are particularly difficult in the context of pregnancy. We analyze common scenarios in medical decision making around pregnancy, from reproductive health policy and clinical care to research protections. We describe three tendencies in these scenarios: 1) to consider the probabilities of undesirable outcomes alone, in isolation from women's values and social contexts, as determinative of individual clinical decisions and health policy; 2) to regard any risk to the fetus, including incremental risks that would in other contexts be regarded as acceptable, as trumping considerations that may be substantially more important to the wellbeing of the pregnant woman; and 3) to focus on the risks associated with undertaking medical interventions during pregnancy to the exclusion of demonstrable risks to both woman and fetus of failing to intervene. These tendencies in the perception, communication, and management of risk can lead to care that is neither evidence-based nor patient-centered, often to the detriment of both women and infants.
评估、沟通和管理风险是医疗实践中最具挑战性的任务之一，在妊娠背景下尤其困难。我们分析了围绕妊娠的医疗决策中的常见情况，从生殖健康政策、临床护理到研究保护。我们描述了这些情况中的三种倾向：1）仅考虑不良后果的概率，而不考虑女性的价值观和社会背景，将其作为个人临床决策和健康政策的决定性因素；2）将对胎儿的任何风险，包括在其他情况下被视为可接受的增量风险，视为比可能对孕妇福祉更重要的因素更具决定性；3）关注与孕期进行医疗干预相关的风险，而忽略不进行干预对女性和胎儿造成的明显风险。这些在风险认知、沟通和管理方面的倾向可能导致既非基于证据也非以患者为中心的护理，往往对女性和婴儿都不利。
