Nurok Michael, Henckes Nicolas
Division of Surgical Critical Care, Cardiac and Thoracic Anesthesia, Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, CWN-L1, Boston, MA 02115, USA.
Soc Sci Med. 2009 Feb;68(3):504-10. doi: 10.1016/j.socscimed.2008.11.001. Epub 2008 Dec 4.
A number of authors have shown how medical decisions are influenced by social values; others have minimized the putative influence of values and have argued that medical decisions are predominantly constrained by the organization of medical work. Based on fieldwork in France and the USA observing pre-hospital resuscitations, we seek to resolve these views by showing that while judgments about the social value of a patient do influence professional decisions, so do judgments about the work that must be accomplished to manage a case. Pre-hospital emergency work has many facets that are variably valued by different professionals at different moments of an emergency's trajectory. These values compete with each other in what we call a "fluctuating economy". This article analyses the role of social, technical, medical or surgical, heroic, and competence values in the course of pre-hospital emergency work. We show how these values may conflict or align with each other, forcing professionals to constantly establish priorities during an emergency trajectory.
许多作者已经表明医学决策是如何受到社会价值观影响的；另一些人则淡化了价值观的假定影响，并认为医学决策主要受到医疗工作组织的限制。基于在法国和美国对院前复苏进行观察的实地调查，我们试图通过表明虽然对患者社会价值的判断确实会影响专业决策，但对处理病例必须完成的工作的判断也会产生同样的影响，来解决这些观点。院前急救工作有许多方面，在紧急情况的不同阶段，不同专业人员对这些方面的重视程度各不相同。这些价值观在我们所称的“波动经济”中相互竞争。本文分析了社会、技术、医疗或外科、英雄主义和能力价值观在院前急救工作过程中的作用。我们展示了这些价值观如何相互冲突或相互一致，迫使专业人员在紧急情况过程中不断确定优先事项。
