Carnevale Franco A, Canoui Pierre, Cremer Robin, Farrell Catherine, Doussau Amélie, Seguin Marie-Josée, Hubert Philippe, Leclerc Francis, Lacroix Jacques
Montreal Children's Hospital, Montreal, Canada.
Pediatr Crit Care Med. 2007 Jul;8(4):337-42. doi: 10.1097/01.PCC.0000269399.47060.6D.
To examine whether physicians or parents assume responsibility for treatment decisions for critically ill children and how this relates to subsequent parental experience. A significant controversy has emerged regarding the role of parents, relative to physicians, in relation to treatment decisions for critically ill children. Anglo-American settings have adopted decision-making models where parents are regarded as responsible for such life-support decisions, while in France physicians are commonly considered the decision makers.
Grounded theory qualitative methodology.
Four pediatric intensive care units (two in France and two in Quebec, Canada).
Thirty-one parents of critically ill children; nine physicians and 13 nurses who cared for their children.
None.
Semistructured interviews were conducted. In France, physicians were predominantly the decision makers for treatment decisions. In Quebec, decisional authority practices were more varied; parents were the most common decision maker, but sometimes it was physicians, while for some decisional responsibility depended on the type of decision to be made. French parents appeared more satisfied with their communication and relationship experiences than Quebec parents. French parents referred primarily to the importance of the quality of communication rather than decisional authority. There was no relationship between parents' actual responsibility for decisions and their subsequent guilt experience.
It was remarkable that a certain degree of medical paternalism was unavoidable, regardless of the legal and ethical norms that were in place. This may not necessarily harm parents' moral experiences. Further research is required to examine parental decisional experience in other pediatric settings.
探讨在重症患儿的治疗决策中，是医生还是家长承担责任，以及这与家长随后的经历有何关联。关于家长相对于医生在重症患儿治疗决策中的作用，已经出现了重大争议。在英美的环境中，采用的决策模式是家长被视为对这种维持生命的决策负责，而在法国，医生通常被认为是决策者。
扎根理论定性方法。
四个儿科重症监护病房（两个在法国，两个在加拿大魁北克）。
31名重症患儿的家长；9名照顾这些患儿的医生和13名护士。
无。
进行了半结构化访谈。在法国，医生主要是治疗决策的制定者。在魁北克，决策权力的实践更为多样；家长是最常见的决策者，但有时是医生，而且对于某些决策，责任取决于决策的类型。法国家长似乎比魁北克家长对他们的沟通和关系体验更满意。法国家长主要提到沟通质量的重要性，而非决策权力。家长对决策的实际责任与他们随后的内疚体验之间没有关联。
值得注意的是，无论现有的法律和道德规范如何，一定程度的医疗家长主义是不可避免的。这不一定会损害家长的道德体验。需要进一步研究来考察其他儿科环境中家长的决策体验。
