Creighton University School of Medicine, Omaha, NE 68178, USA.
Am J Bioeth. 2009 Oct;9(10):20-8. doi: 10.1080/15265160902985001.
This target article focuses on dynamics that arise in three typical ethically complex cases in which psychiatric consultations are requested by physicians: a dying patient refuses life-prolonging treatment, an uncooperative patient demands to be allowed to go outside and smoke, and an angry patient demands to be admitted to the hospital. The discussion canvasses what is at stake morally and clinically in each of these cases and explores clinician-patient interactions, dynamics in relationships between consulting physicians and consultant psychiatrists, patient transference, and physician countertransference. The article defines legalism and countertransference and argues that an ethically and clinically important consequence of these phenomena for patients is distortion of clinicians' perceptions of patients' decisions and vulnerabilities. The discussion also describes how legalism and countertransference adversely affect how clinicians treat their psychiatrist colleagues. Finally, the article suggests how the effects of legalism and countertransference can be mitigated.
这篇专题文章聚焦于三种典型的、具有伦理复杂性的情况下出现的动力学问题，这些情况涉及到医生请求精神科会诊：濒死的患者拒绝延长生命的治疗，不合作的患者要求被允许外出吸烟，以及愤怒的患者要求住院。本文讨论了这些案例中在道德和临床方面的利害关系，并探讨了医患互动、会诊医生和顾问精神科医生之间的关系动态、患者的移情以及医生的反移情。本文定义了法律主义和反移情，并认为这些现象对患者的一个重要的伦理和临床后果是扭曲了临床医生对患者决策和脆弱性的看法。本文还描述了法律主义和反移情如何对临床医生对待他们的精神科同事产生不利影响。最后，本文提出了如何减轻法律主义和反移情的影响。
