Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030-3411, USA.
Med Care Res Rev. 2013 Feb;70(1 Suppl):141S-158S. doi: 10.1177/1077558712461952. Epub 2012 Nov 1.
The professional medical ethics model of decision making may be applied to decisions clinicians and patients make under the conditions of clinical uncertainty that exist when evidence is low or very low. This model uses the ethical concepts of medicine as a profession, the professional virtues of integrity and candor and the patient's virtue of prudence, the moral management of medical uncertainty, and trial of intervention. These features combine to justifiably constrain clinicians' and patients' autonomy with the goal of preventing nondeliberative decisions of patients and clinicians. To prevent biased recommendations by the clinician that promote such nondeliberative decisions, medically reasonable alternatives supported by low or very low evidence should be offered but not recommended. The professional medical ethics model of decision making aims to improve the quality of decisions by reducing the unacceptable variation that can result from nondeliberative decision making by patients and clinicians when evidence is low or very low.
专业医学伦理决策模型可应用于临床医生和患者在存在低或极低证据情况下的临床不确定性条件下做出的决策。该模型使用医学作为职业的伦理概念、正直和坦诚的专业美德以及患者的谨慎美德、对医疗不确定性的道德管理和干预试验。这些特征结合起来,可以合理地限制临床医生和患者的自主权,目的是防止患者和临床医生做出非深思熟虑的决策。为了防止临床医生的推荐存在偏见,从而导致这种非深思熟虑的决策,应提供但不推荐低或极低证据支持的合理医学替代方案。专业医学伦理决策模型旨在通过减少在低或极低证据情况下患者和临床医生非深思熟虑决策可能导致的不可接受的变化,来提高决策质量。