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面对医院日益商业化的伦理决策:一项关于学生和医生在住院时长决策中伦理不信任的研究

[Ethical decision-making in the face of increasing economization of hospitals : A study on ethical mistrust in decisions taken on the length of hospital stay among students and doctors].

作者信息

Alkatout Ibrahim, Strack Micha, Maass Nicolai, Boos Margarete, Hopf Norbert

机构信息

Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Kiel School of Gynecological Endoscopoy, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3 / Haus 1B, 24105, Kiel, Deutschland.

Georg-Elias-Müller-Institut für Psychologie, Georg-August-Universität Göttingen, Goßlerstraße 14, 37073, Göttingen, Deutschland.

出版信息

Wien Med Wochenschr. 2020 Oct;170(13-14):367-375. doi: 10.1007/s10354-020-00742-5. Epub 2020 Feb 28.

Abstract

Are medical values receding in importance because of economization of the German health system? Within the frame of a vignette study, a case is presented based on prolongation of the hospitalization of an elderly and not entirely recovered patient. All respondents of the questionnaire predicted the relevance of decision criteria, such as medical accuracy, empathy towards the patient, and identification with the hospital. Participants (N = 1,239) believe that decision-makers view medical accuracy as the most important criterion, followed by empathy. The more the respondent had universalistic values, the more likely the person was to favor an extended hospitalization. The more security-oriented and less pro-social the respondent, the more likely the person was to support an early discharge. It can be concluded that in the course of their training doctors acquire their grounded deontological-ethical decision-making autonomy, which may in some cases contradict existing regulations.

摘要

德国医疗体系的经济化是否导致医疗价值的重要性在下降?在一项基于vignette研究的框架下,呈现了一个案例,该案例是关于一位未完全康复的老年患者住院时间延长的情况。问卷的所有受访者都预测了决策标准的相关性,比如医疗准确性、对患者的同理心以及对医院的认同感。参与者(N = 1239)认为决策者将医疗准确性视为最重要的标准,其次是同理心。受访者的普遍主义价值观越强,就越倾向于支持延长住院时间。受访者的安全感越强且亲社会程度越低,就越有可能支持提前出院。可以得出结论,在培训过程中,医生获得了基于道义论伦理的决策自主权,这在某些情况下可能与现行规定相矛盾。

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