Kraus Chadd K, Marco Catherine A
Department of Emergency Medicine, University of Missouri-Columbia, 1 Hospital Dr, DC029.10, Suite M562, Columbia, MO, 65212.
Department of Emergency Medicine, Wright State University, Boonshaft School of Medicine, Dayton, OH.
Am J Emerg Med. 2016 Aug;34(8):1668-72. doi: 10.1016/j.ajem.2016.05.058. Epub 2016 May 24.
The process of shared decision making (SDM) is an ethical imperative in the physician-patient relationship, especially in the emergency department (ED), where SDM can present unique challenges because patients and emergency physicians often have no established relationship and decisions about diagnosis, treatment, and disposition are time dependent. SDM should be guided by the ethical principles of autonomy, beneficence, nonmaleficence, and justice and the related principle of stewardship of finite resources. The objective of this article is to outline the ethical considerations of SDM in the ED in the context of diagnostic evaluations, therapeutic interventions, disposition decisions, and conflict resolution and to explore strategies for reaching decision consensus. Several cases are presented to highlight the ethical principles in SDM in the ED. SDM is an important approach to diagnostic testing in the ED. Achieving agreement regarding diagnostic evaluations requires a balance of respect for patient autonomy and stewardship of resources. SDM regarding ED therapeutic interventions is an important component of the balance of respect for patient autonomy and beneficence. While respecting patient autonomy, emergency physicians also recognize the importance of the application of professional judgment to achieve the best possible outcome for patients. SDM as an ethical imperative in the context of ED disposition is especially important because of the frequent ambiguity of equipoise in these situations. Unique clinical situations such as pediatric patients or patients who lack decisional capacity merit special consideration.
共同决策（SDM）过程在医患关系中是一项伦理要求，在急诊科（ED）尤为如此，在急诊科，共同决策可能带来独特挑战，因为患者与急诊医生通常没有既存关系，且关于诊断、治疗和处置的决策具有时间依赖性。共同决策应以自主、行善、不伤害和公正等伦理原则以及有限资源管理的相关原则为指导。本文的目的是概述在诊断评估、治疗干预、处置决策和冲突解决背景下急诊科共同决策的伦理考量，并探讨达成决策共识的策略。文中呈现了几个案例以突出急诊科共同决策中的伦理原则。共同决策是急诊科诊断检测的重要方法。就诊断评估达成一致需要在尊重患者自主权和资源管理之间取得平衡。急诊科治疗干预方面的共同决策是尊重患者自主权与行善平衡的重要组成部分。在尊重患者自主权的同时，急诊医生也认识到运用专业判断以实现患者最佳预后的重要性。在急诊科处置背景下，共同决策作为一项伦理要求尤为重要，因为在这些情况下平衡常常不明确。诸如儿科患者或缺乏决策能力的患者等特殊临床情况值得特别考虑。
