Hermann Helena, Trachsel Manuel, Biller-Andorno Nikola
Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.
J Med Ethics. 2015 Sep;41(9):739-44. doi: 10.1136/medethics-2014-102263. Epub 2015 Mar 17.
Decision-making capacity (DMC) evaluations are complex clinical judgements with important ethical implications for patients' self-determination. They are achieved not only on descriptive grounds but are inherently normative and, therefore, dependent on the values held by those involved in the DMC evaluation. To date, the issue of whether and how physicians' personal values relate to DMC evaluation has never been empirically investigated. The present survey study aimed to investigate this question by exploring the relationship between physicians' value profiles and the use of risk-relative standards in capacity evaluations. The findings indicate that physicians' personal values are of some significance in this regard. Those physicians with relatively high scores on the value types of achievement, power-resource, face and conformity to interpersonal standards were more likely to apply risk-relative criteria in a range of situations, using more stringent assessment standards when interventions were riskier. By contrast, those physicians who strongly emphasise hedonism, conformity to rules and universalism concern were more likely to apply equal standards regardless of the consequences of a decision. Furthermore, it has been shown that around a quarter of all respondents do not appreciate that their values impact on their DMC evaluations, highlighting a need to better sensitise physicians in this regard. The implications of these findings are discussed, especially in terms of the moral status of the potential and almost unavoidable influence of physicians' values.
决策能力（DMC）评估是复杂的临床判断，对患者的自主决定权具有重要的伦理意义。这些评估不仅基于描述性依据，而且本质上具有规范性，因此取决于参与DMC评估的人员所秉持的价值观。迄今为止，医生的个人价值观与DMC评估之间是否存在关联以及如何关联的问题从未得到实证研究。本调查研究旨在通过探索医生的价值观概况与能力评估中风险相关标准的使用之间的关系来调查这个问题。研究结果表明，医生的个人价值观在这方面具有一定意义。在成就、权力资源、面子和符合人际标准等价值类型上得分相对较高的医生，在一系列情况下更有可能应用风险相关标准，在干预风险较高时使用更严格的评估标准。相比之下，那些强烈强调享乐主义、遵守规则和普遍主义关注的医生，无论决策后果如何，更有可能应用平等标准。此外，研究表明，约四分之一的受访者没有意识到他们的价值观会影响他们的DMC评估，这凸显了在这方面提高医生敏感度的必要性。本文讨论了这些研究结果的意义，特别是从医生价值观潜在且几乎不可避免的影响的道德地位方面进行了讨论。
