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当照顾者忽视无知之幕时会怎样?一项关于医疗分诊决策的实证研究。

When do caregivers ignore the veil of ignorance? An empirical study on medical triage decision-making.

机构信息

Forensic Psychiatry Unit, Yehuda Abarbanel Mental Health Center, Bat Yam, Israel.

Adolescent Psychiatry Department, Beer Yaakov-Ness Ziona Mental Health Center, Beer Yaakov, Israel.

出版信息

Med Health Care Philos. 2021 Jun;24(2):213-225. doi: 10.1007/s11019-020-09992-x. Epub 2021 Jan 4.

Abstract

In principle, all patients deserve to receive optimal medical treatment equally. However, in situations in which there is scarcity of time or resources, medical treatment must be prioritized based on a triage. The conventional guidelines of medical triage mandate that treatment should be provided based solely on medical necessity regardless of any non-medical value-oriented considerations ("worst-first"). This study empirically examined the influence of value-oriented considerations on medical triage decision-making. Participants were asked to prioritize medical treatment relating to four case scenarios of an emergency situation resulting from a car collision. The cases differ by situational characteristics pertaining to the at-fault driver, which were related to culpability attribution.In three case scenarios most participants gave priority to the most severely injured individual, unless the less severely injured individual was their brother. Nevertheless, in the aftermath of a vehicle-ramming terror attack most participants prioritized the less severely injured individual ("victim-first").Our findings indicate that when caregivers are presented with concrete highly conflictual triage situations their choices may be based on value-oriented considerations related to contextual characteristics of the emergency situation. Philosophical and practical ramifications of our findings are discussed.

摘要

原则上,所有患者都应平等获得最佳的医疗待遇。然而,在时间或资源有限的情况下,必须根据分诊对医疗进行优先排序。传统的医疗分诊准则规定,治疗应仅根据医疗必要性提供,而不考虑任何非医疗价值导向的考虑因素(“先重后轻”)。本研究实证检验了价值导向的考虑因素对医疗分诊决策的影响。要求参与者根据车祸造成的紧急情况的四个案例场景优先考虑医疗治疗。这些病例在与有责司机相关的情境特征方面存在差异,这些特征与罪责归因有关。在三个案例场景中,大多数参与者优先考虑伤势最严重的个体,除非伤势较轻的个体是他们的兄弟。然而,在车辆冲撞恐怖袭击事件发生后,大多数参与者优先考虑伤势较轻的个体(“先救弱者”)。我们的研究结果表明,当护理人员面对具体的高度冲突的分诊情况时,他们的选择可能基于与紧急情况的情境特征相关的价值导向考虑因素。我们的研究结果在哲学和实践方面的意义进行了讨论。

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