Division of Neonatology and Clinical Ethics, Department of Pediatrics, University of Montreal, Sainte-Justine Hospital, Montreal, QC, Canada.
Acta Paediatr. 2012 Aug;101(8):800-4. doi: 10.1111/j.1651-2227.2012.02695.x. Epub 2012 May 4.
When physicians are asked for a consult for women in premature labour, they face a complex set of challenges. Policy statements recommend that women be given detailed information about the risks of various outcomes, including death, long-term disability and various specific neonatal problems. Both personal narratives and studies suggest that parents also base their decisions on factors other than the probabilistic facts about expected outcomes. Statistics are difficult to understand at any time. Rational decision-making may be difficult when taking life-and-death decisions. Furthermore, the role of emotions is not discussed in peri-viability guidelines.
We argue against trying to tell parents every fact that we think might be relevant to their decision. This may be overwhelming for many parents. Instead, doctors should try to discern, on a case-by-case basis, what particular parents want and need. Information and delivery of information should be personalized. Unfortunately, evidence in this area is limited.
当医生被要求为早产妇女提供咨询时，他们面临着一系列复杂的挑战。政策声明建议向妇女提供有关各种结果风险的详细信息，包括死亡、长期残疾和各种特定的新生儿问题。个人叙述和研究都表明，父母的决定也不仅仅基于对预期结果的概率事实。任何时候统计数据都很难理解。在做出生死攸关的决定时，理性决策可能很困难。此外，围产生存能力指南中并未讨论情绪的作用。
我们反对试图告诉父母我们认为可能与他们的决定相关的每一个事实。这可能会让许多父母感到不知所措。相反，医生应该尝试根据具体情况辨别出特定父母的需求。信息的提供应该个性化。不幸的是，这方面的证据有限。
