Stevens N G, McCormick T R
University of Washington.
J Med Ethics. 1994 Jun;20(2):112-7. doi: 10.1136/jme.20.2.112.
As part of an ethics course, health professions students were asked to identify ethical issues and to propose resolutions before and after a class discussion of a case involving confidentiality and substance abuse. Students listed an average of 2.4 issues before and 3.6 issues after the discussion. After discussion 50 per cent of students made explicit changes in their proposed resolution. Opinions varied widely on breaching confidentiality and the responsibility for protecting the patient's health. After the discussion almost 20 per cent of the class felt it was acceptable to breach confidentiality as long as the patient was unaware. Many students identified more with the health care provider than with the patient. The presence of substance abuse altered many students' views on confidentiality. In this experience students were less rigorous in their application of principles, creating an excellent opportunity for teaching through exploration of the complexity of ethical decision-making in a specific case.
作为一门伦理学课程的一部分，健康专业的学生被要求在课堂讨论一个涉及保密和药物滥用的案例之前和之后，识别伦理问题并提出解决方案。学生们在讨论前平均列出2.4个问题，讨论后平均列出3.6个问题。讨论后，50%的学生对他们提出的解决方案做出了明确的改变。对于违反保密规定以及保护患者健康的责任，意见差异很大。讨论后，近20%的学生认为只要患者不知情，违反保密规定是可以接受的。许多学生更认同医疗服务提供者而不是患者。药物滥用的存在改变了许多学生对保密的看法。在这次经历中，学生们在应用原则时不够严谨，这为通过探索特定案例中伦理决策的复杂性进行教学创造了绝佳机会。
