Lynøe Niels, Helgesson Gert, Juth Niklas
Centre for healthcare ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden.
Clin Ethics. 2018 Sep;13(3):151-158. doi: 10.1177/1477750918765283. Epub 2018 Mar 27.
Clinical decisions are expected to be based on factual evidence and official values derived from healthcare law and soft laws such as regulations and guidelines. But sometimes personal values instead influence clinical decisions. One way in which personal values may influence medical decision-making is by their affecting factual claims or assumptions made by healthcare providers. Such influence, which we call 'value-impregnation,' may be concealed to all concerned stakeholders. We suggest as a hypothesis that healthcare providers' decision making is sometimes affected by value-impregnated factual claims or assumptions. If such claims influence e.g. doctor-patient encounters, this will likely have a negative impact on the provision of correct information to patients and on patients' influence on decision making regarding their own care. In this paper, we explore the idea that value-impregnated factual claims influence healthcare decisions through a series of medical examples. We suggest that more research is needed to further examine whether healthcare staff's personal values influence clinical decision-making.
临床决策理应基于事实证据以及源自医疗保健法和诸如法规及指南等软法的官方价值观。但有时个人价值观反而会影响临床决策。个人价值观可能影响医疗决策的一种方式是，它们会影响医疗服务提供者提出的事实主张或假设。这种影响，我们称之为“价值渗透”，可能对所有相关利益攸关方都隐藏着。我们提出一个假设，即医疗服务提供者的决策有时会受到价值渗透的事实主张或假设的影响。如果此类主张影响例如医患互动，这很可能会对向患者提供正确信息以及患者对自身护理决策的影响产生负面影响。在本文中，我们通过一系列医学实例探讨价值渗透的事实主张影响医疗决策的观点。我们认为需要更多研究来进一步考察医护人员的个人价值观是否会影响临床决策。
