Wasson Katherine, Kuczewski Mark, McCarthy Michael P, Parsi Kayhan, Anderson Emily E, Hutchison Paul
From the Neiswanger Institute for Bioethics, Stritch School of Medicine, Loyola University Chicago, and Pulmonary and Critical Care Medicine, Loyola University Health System, Maywood, Illinois.
South Med J. 2017 Mar;110(3):195-199. doi: 10.14423/SMJ.0000000000000615.
Case-based learning is a staple of clinical ethics education in medicine. The sources for medical educators generally are lengthy case books or single, often rare, case analyses in the literature. Busy clinicians may not have the time or inclination to sift through case books to find suitable teaching material, and the latter present unusual cases that many physicians may never encounter in their own practice. Relatively few articles present multiple cases involving ethical issues that are likely to appear in everyday practice in an accessible format for teaching. To fill this gap, we developed a series of paradigmatic cases based on the recurrent themes we identified through a systematic analysis of our clinical ethics consultations in a 5-year period and our collective clinical ethics judgment. We constructed four amalgam "bread-and-butter" ethics cases that are not overly service specific and can be used in medical and residency education along with specific questions for discussion. Topics include decision-making capacity, withholding and withdrawing life-sustaining treatment, patient wishes and do not resuscitate orders, and brain death. Our objective was to help a range of residents and other physicians become more confident and facile in identifying and addressing recurrent ethical issues in their practice.
基于案例的学习是医学临床伦理教育的主要方式。医学教育工作者的资料来源通常是冗长的案例书籍，或者是文献中单个的、往往很罕见的案例分析。忙碌的临床医生可能没有时间或意愿去翻阅案例书籍以寻找合适的教学材料，而且后者呈现的是许多医生在自己的实践中可能从未遇到过的特殊案例。相对较少的文章以便于教学的形式呈现多个涉及日常实践中可能出现的伦理问题的案例。为了填补这一空白，我们根据在5年期间对临床伦理咨询进行系统分析以及我们的集体临床伦理判断所确定的反复出现的主题，开发了一系列范例案例。我们构建了四个综合的“常见”伦理案例，这些案例不过度针对特定服务，可以用于医学教育和住院医师培训，并配有具体的讨论问题。主题包括决策能力、维持生命治疗的 withhold 和撤除、患者意愿和不进行心肺复苏医嘱以及脑死亡。我们的目标是帮助一系列住院医师和其他医生在识别和处理实践中反复出现的伦理问题时更加自信和得心应手。
