Lynöe Niels, Juth Niklas
Karolinska Institutet, Stockholm, Sweden,
Med Health Care Philos. 2013 Nov;16(4):789-93. doi: 10.1007/s11019-012-9460-2.
The aim of the present study was to compare and examine how medical students on term one and nine understand and adopt ideas and reasoning when estimating death-causes. Our hypothesis was that compared to students in the beginning of their medical curriculum, term nine students would be more inclined to adopt ideas about causality that allows physicians to alleviate an imminently dying patient, without being suspected for manslaughter--a practice referred to as proficiency creativity. We used a questionnaire containing two similar cases describing an imminently dying patient who receive a drug in order to treat seizures. The treatment has the foreseen effect of shortening the patient's life. In one version of the vignette the patient dies immediately and in the other one the patient dies 5 h after having received the drug. We asked medical students in their first term (n = 149) and ninth term (n = 106) to fill in the two randomly distributed questionnaires. We used a χ2 test to examine our hypothesis and choose as significance level 0.05. A majority of term-one students (53%) stated that the patient died because of the provided drugs when dying immediately after and 32% stated it when the patient died 5 h after providing the drug. The difference was significant (p = 0.007). A minority of term-nine students (20 vs. 16%) stated the patient died because of the provided drug. The difference was not significant. The study indicates that term-nine students have espoused the idea that death-causes in such cases should always be classified as the underlying disease--even though another straightforward explanation could be the drug provided. To clinicians this might be a proficiency-creative strategy for managing a difficult legal dilemma. As hypothetical explanation we suggest that experienced clinicians might have transformed a normative issue of shortening life into an empirical issue about death-causes and tacitly transferred this strategy to term-nine students. If our hypothesis is supported by future studies, this kind of transferring proficiency creativity tacitly might impede changing the Penal Code even though it may be needed.
本研究的目的是比较和考察一年级和九年级的医学生在估计死因时如何理解和采用相关观点及推理方式。我们的假设是，与医学课程刚开始时的学生相比，九年级的学生更倾向于采用关于因果关系的观点，这种观点能使医生在不被怀疑犯有过失杀人罪的情况下减轻即将死亡患者的痛苦——这种做法被称为专业创造力。我们使用了一份问卷，其中包含两个类似的案例，描述了一名即将死亡的患者为治疗癫痫而接受一种药物治疗。这种治疗具有缩短患者生命的预期效果。在一个案例版本中，患者立即死亡，在另一个版本中，患者在接受药物治疗5小时后死亡。我们让一年级医学生（n = 149）和九年级医学生（n = 106）填写这两份随机分发的问卷。我们使用卡方检验来检验我们的假设，并选择0.05作为显著性水平。大多数一年级学生（53%）表示，患者在接受药物治疗后立即死亡是因为所提供的药物，32%的一年级学生表示在患者接受药物治疗5小时后死亡时是因为所提供的药物。差异具有显著性（p = 0.007）。少数九年级学生（分别为20%和16%）表示患者死于所提供的药物。差异不具有显著性。该研究表明，九年级学生支持这样一种观点，即在此类案例中，死因应始终归类为潜在疾病——尽管另一个直接的解释可能是所提供的药物。对临床医生来说，这可能是一种处理棘手法律困境的专业创造性策略。作为一种假设性解释，我们认为经验丰富的临床医生可能已将缩短生命的规范性问题转化为关于死因的实证性问题，并将这种策略潜移默化地传授给了九年级学生。如果我们的假设得到未来研究的支持，这种潜移默化地传授专业创造力的做法可能会阻碍刑法典的修订，尽管这可能是必要的。
