Lynöe Niels, Björk Joar, Juth Niklas
Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Sweden.
Department of Research and Development, Region Kronobe.
Clin Ethics. 2017 Sep;12(3):117-123. doi: 10.1177/1477750917704157. Epub 2017 Apr 19.
Swedish healthcare providers are supposed to be value-neutral when making clinical decisions. Recent conducted studies among Swedish physicians have indicated that the proportion of those whose personal values influence decision-making (the value-influenced) vary depending on the framing and the nature of the issue.
To examine whether the proportions of value-influenced and value-neutral participants vary depending on the extent to which the intervention is considered controversial.
To discriminate between value-neutral and value-influenced healthcare providers, we have used the same methods in six vignette based studies including 10 more or less controversial interventions. To be controversial was understood as being an intervention where conscientious objections in healthcare have been proposed or an intervention that is against law and regulations.
End of life decisions and female reproduction issues are associated with conscientious objection and more or less against regulations, and also resulted in the highest proportions of value-influenced participants. Following routines, which is not in conflict with official values, were associated with one of the lowest proportion of value-influenced participants. The difference between the highest and lowest proportions of value-influenced participants among the 10 examined interventions was significant (81.8% (95% confidence interval: 78.1-85.5) versus 34.7% (95% confidence interval: 29.2-40.2)).
The study indicates that the proportions of value-neutral participants decrease the more controversial an issue is, and vice versa. In some cases, however, framing effects may potentiate or obscure this association. As a bold hypothesis, we suggest the proportion of value-neutral or value-influenced might indicate how controversial an issue is.
瑞典医疗服务提供者在做出临床决策时应保持价值中立。最近对瑞典医生进行的研究表明，其个人价值观影响决策的医生比例（受价值观影响者）会因问题的框架和性质而有所不同。
研究受价值观影响和价值中立的参与者比例是否会因干预措施被认为有争议的程度而有所不同。
为区分价值中立和受价值观影响的医疗服务提供者，我们在六项基于案例的研究中采用了相同方法，这些研究涉及10种或多或少有争议的干预措施。有争议被理解为是一种在医疗保健中有人提出良心反对意见的干预措施，或是一种违反法律法规的干预措施。
临终决策和女性生殖问题与良心反对意见相关，或多或少违反规定，并且受价值观影响的参与者比例也最高。遵循与官方价值观不冲突的常规流程，其受价值观影响的参与者比例是最低的之一。在10种被研究的干预措施中，受价值观影响的参与者比例最高值与最低值之间的差异具有显著性（81.8%（95%置信区间：78.1 - 85.5）对34.7%（95%置信区间：29.2 - 40.2））。
该研究表明，问题争议越大，价值中立的参与者比例越低，反之亦然。然而，在某些情况下，框架效应可能会增强或掩盖这种关联。作为一个大胆的假设，我们认为价值中立或受价值观影响的比例可能表明一个问题的争议程度。
