Departments of Obstetrics and Gynecology, and
Medicine, Indianapolis, Indiana; Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, Indiana; and.
Pediatrics. 2015 Oct;136(4):740-5. doi: 10.1542/peds.2015-1808.
This article presents a previously published framework, summarized in the mnemonic ANSWER (A, Active listening; N, Needs assessment; S, Self-awareness/reflection; W, Whose perspective?; E, Elicit values; R, Respond) for how to respond to the question, "Doctor, what would you do?" when considering medical decisions that are preference-sensitive, meaning there is limited or debatable evidence to guide clinical recommendations, or are value-laden, such that the "right" decision may differ based on the context or values of a given individual. Using the mnemonic and practical examples, we attempt to make the framework for an ethically appropriate approach to these conversations more accessible for clinicians. Rather than a decision rule, this mnemonic represents a set of points to consider when physicians are considering an ethically acceptable response that fosters trust and rapport. We apply this approach to a case of periviable counseling, among the more emotionally challenging and value-laden antenatal decisions faced by providers and patients.
本文提出了一个先前发表的框架，用首字母缩略词 ANSWER（A，主动倾听；N，需求评估；S，自我意识/反思；W，从谁的角度看？；E，引出价值观；R，回应）来回答这个问题，“医生，你会怎么做？”当考虑偏好敏感的医疗决策时，这意味着有限或有争议的证据来指导临床建议，或者是有价值的，这样“正确”的决策可能会因给定个体的背景或价值观而有所不同。我们使用这个首字母缩略词和实际例子，试图使这个框架更易于临床医生理解，从而以一种合乎道德的方式来进行这些对话。这个首字母缩略词并不代表决策规则，而是代表当医生考虑一种可以促进信任和融洽关系的合乎道德的可接受回应时需要考虑的一系列要点。我们将这种方法应用于一个围产儿咨询的案例中，这是提供者和患者面临的更具情感挑战性和更有价值的产前决策之一。
