Lown Beth A, Victor Karen E
A general internist affiliated with Mount Auburn Hospital in Cambridge, Massachusetts, and an associate professor of medicine at Harvard Medical School and the chief medical officer of the Schwartz Center for Compassionate Healthcare.
A general internist at Mount Auburn Hospital in Cambridge, Massachusetts, and an assistant professor of medicine at Harvard Medical School in Boston.
AMA J Ethics. 2018 Nov 1;20(11):E1007-1016. doi: 10.1001/amajethics.2018.1007.
This case of a patient whose physician refuses to prescribe statins for high cholesterol raises ethical issues about a physician's decision to offer clinical recommendations contrary to current practice guidelines. Our response summarizes social forces that have led to the rise of evidence-based medicine, the development of clinical guidelines, and the evolution of the roles of physicians and patients in decision making. We conclude that there are times when a physician can justifiably make a recommendation to a patient that contravenes a current clinical guideline. In making such a recommendation, we suggest that a physician should communicate a rationale for deviating from clinical guidelines and respect a patient's autonomy. We consider the need for and limitations of clinical guidelines, numerous factors influencing shared decision making, and key ethical principles of nonmaleficence and respect for patient autonomy.
该病例中，患者的医生拒绝为其高胆固醇症状开具他汀类药物，这引发了有关医生做出与现行实践指南相悖的临床建议这一决定的伦理问题。我们的回应总结了促使循证医学兴起、临床指南发展以及医生和患者在决策中角色演变的社会力量。我们得出结论，有时医生可以合理地向患者提出违背现行临床指南的建议。在提出此类建议时，我们建议医生应说明偏离临床指南的理由，并尊重患者的自主权。我们考虑了临床指南的必要性和局限性、影响共同决策的众多因素以及不伤害和尊重患者自主权的关键伦理原则。
