伦理决策：麻醉师、外科医生、护士麻醉师和外科护士的推理是否相似？
Ethical decision-making: do anesthesiologists, surgeons, nurse anesthetists, and surgical nurses reason similarly?
机构信息
Postoperative and Interventional Pain Unit, Department Anesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva.
出版信息
Pain Med. 2008 Sep;9(6):728-36. doi: 10.1111/j.1526-4637.2007.00346.x.
BACKGROUND
Principle-based ethical theory is currently available to guide health care professionals in clinical decision-making when they face ethical dilemmas. These principles include respect for autonomy (RA), nonmaleficence (NM), beneficence (B), and distributive justice. It is, however,unknown which principles, if any, guide physicians and nurses in this decision-making. The goal of our study was to explore how anesthesiologists, surgeons, nurses, and nurse anesthetists reason in the face of a moral dilemma.
METHODS
By an anonymous survey we asked: Would you give a blood transfusion to a young, ASA I, Jehovah’s Witness who clearly refused transfusion, in a case of a life-threatening bleeding? What ethical principle did you apply in your decision?We presented this question before and after a 1-hour ethical tutorial about these principles.
RESULTS
Twenty-nine anesthesiologists, 41 surgeons, 21 surgical nurses, and 33 nurse anesthetists participated in our survey. We found that 59%, 30%, 29%, and 36% of anesthesiologists, surgeons,surgical nurses, and nurse anesthetists, respectively, would give a blood transfusion despite the patient’s demand. Nurses used B, surgeons NM, and anesthesiologists B and NM to justify transfusion. However, two among 11 anesthesiologists and five among 12 surgeons did not explain their choice. Those who tend to withhold blood transfusion overwhelmingly used RA as the principle behind this decision. Nine participants changed their view before and after the tutorial. There was no correlation between gender, age, and professional experience with the choice of principle. The average interest score for the tutorial was 74/100 for all participants after this ethical course.
CONCLUSIONS
Anesthesiologists tend to transfuse Jehovah’s Witness patients more than did the others. Together with surgeons, they explicitly justify their decision-making less frequently when compared with nurses and nurse anesthetists. Further education in ethical theory is appreciated and needed.
背景
目前，基于原则的伦理理论可用于指导医疗保健专业人员在面临伦理困境时做出临床决策。这些原则包括尊重自主权（RA）、不伤害（NM）、行善（B）和分配公正。然而，尚不清楚在这种决策中，哪些原则（如果有的话）指导医生和护士。我们的研究目的是探讨麻醉师、外科医生、护士和护士麻醉师在面对道德困境时是如何推理的。
方法
我们通过匿名调查询问：在危及生命的出血情况下，您是否会给一位年轻的 ASA I 级、明确拒绝输血的耶和华见证人输血？您在决定中应用了哪些伦理原则？我们在介绍这些原则的 1 小时伦理教程之前和之后提出了这个问题。
结果
29 名麻醉师、41 名外科医生、21 名外科护士和 33 名护士麻醉师参加了我们的调查。我们发现，分别有 59%、30%、29%和 36%的麻醉师、外科医生、外科护士和护士麻醉师会给患者输血，尽管患者有需求。护士使用 B，外科医生使用 NM，麻醉师使用 B 和 NM 来证明输血是合理的。然而，11 名麻醉师中有 2 名和 12 名外科医生中有 5 名没有解释他们的选择。那些倾向于拒绝输血的人压倒性地使用 RA 作为他们决策背后的原则。在教程前后，有 9 名参与者改变了他们的观点。性别、年龄和专业经验与原则选择之间没有相关性。所有参与者在完成伦理课程后的平均兴趣评分为 74/100。
结论
麻醉师倾向于给耶和华见证人患者输血，比其他医生更频繁。与护士和护士麻醉师相比，他们在做出决策时明确解释的频率较低，与外科医生一起。需要进一步的伦理理论教育。
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