Centre for Healthcare Ethics, Karolinska Institute, 171 77, Stockholm, Sweden.
University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
BMC Med Ethics. 2021 Dec 28;22(1):170. doi: 10.1186/s12910-021-00739-8.
We aim to further develop an index for detecting disguised paternalism, which might influence physicians' evaluations of whether or not a patient is decision-competent at the end of life. Disguised paternalism can be actualized when physicians transform hard paternalism into soft paternalism by questioning the patient's decision-making competence.
A previously presented index, based on a cross-sectional study, was further developed to make it possible to distinguish between high and low degrees of disguised paternalism using the average index of the whole sample. We recalculated the results from a 2007 study for comparison to a new study conducted in 2020. Both studies are about physicians' attitudes towards, and arguments for or against, physician-assisted suicide.
The 2020 study showed that geriatricians, palliativists, and middle-aged physicians (46-60 years old) had indices indicating disguised paternalism, in contrast with the results from the 2007 study, which showed that all specialties (apart from GPs and surgeons) had indices indicating high degrees of disguised paternalism.
The proposed index for identifying disguised paternalism reflects the attitude of a group towards physician assisted suicide. The indices make it possible to compare the various medical specialties and age groups from the 2007 study with the 2020 study. Because disguised paternalism might have clinical consequences for the rights of competent patients to participate in decision-making, it is important to reveal disguised hard paternalism, which could masquerade as soft paternalism and thereby manifest in practice. Methods for improving measures of disguised paternalism are worthy of further development.
我们旨在进一步开发一个能够检测伪装家长主义的指标，这可能会影响医生对患者在生命末期是否有决策能力的评估。当医生通过质疑患者的决策能力将强硬家长主义转化为软性家长主义时，伪装家长主义就会实现。
基于一项横断面研究，进一步开发了一个之前提出的指标，以使用整个样本的平均指标来区分高伪装家长主义和低伪装家长主义的程度。我们重新计算了 2007 年研究的结果，以便与 2020 年进行的一项新研究进行比较。这两项研究都是关于医生对医生协助自杀的态度，以及支持或反对医生协助自杀的论点。
2020 年的研究表明，老年病学家、姑息治疗学家和中年医生（46-60 岁）的指标表明存在伪装家长主义，而 2007 年的研究结果表明，所有专业（全科医生和外科医生除外）的指标都表明存在高度的伪装家长主义。
用于识别伪装家长主义的建议指标反映了一组人对医生协助自杀的态度。这些指标可以比较 2007 年研究中的各个医学专业和年龄组与 2020 年研究的结果。因为伪装家长主义可能对有能力参与决策的患者的权利产生临床后果，所以揭示伪装的强硬家长主义是很重要的，它可能伪装成软性家长主义，并因此在实践中表现出来。改进伪装家长主义措施的方法值得进一步发展。
