Self D J, Skeel J D, Jecker N S
Department of Humanities in Medicine, Texas A&M University Health Science Center College of Medicine, College Station 77843-1114.
Acad Med. 1993 Nov;68(11):852-5. doi: 10.1097/00001888-199311000-00014.
Because of the increasing controversy over who should provide ethics consultations, this study investigated differences in the moral reasoning and moral orientations of physicians and clinical ethicists.
From 1987 through 1990, extensive interviews were conducted with 39 physicians and 50 clinical medical ethicists (26 philosophers and 24 theologians) who were at 32 medical centers in 14 states from all sections of the United States. The interviews were used to gather selected demographic characteristics (age, gender, and profession--physician or ethicist) for the 89 individuals as well as to determine their scores for moral reasoning and moral orientation. Polyserial correlations and multivariant analyses were then performed between the demographic characteristics and the data on moral reasoning and moral orientation.
The physicians consistently scored lower than the clinical ethicists in their moral reasoning skills in terms of both moral stage score (p < .01) and weighted average score (p < .01). However, the physicians were found not to be significantly different (p < .05) from the clinical ethicists in their moral orientations toward justice or care in terms of recognition, predominance, or alignment. No significant relationship was found between age and moral orientation. A significant relationship was found between age and stage of moral reasoning, with the older individuals scoring higher. No significant relationship was found between gender and stage of moral reasoning. A significant relationship was found between gender and moral orientation: the women were more likely to recognize elements of care in moral dilemmas and the men more likely to recognize elements of justice.
This study provides initial evidence that clinical medical ethicists, whether philosophers or theologians, may be better skilled than physicians to do ethicists consultations. To the extent that higher levels of moral reasoning correlate with superior skills in performing clinical ethics consultations, this study shows the value of bringing philosophers and theologians into the clinical setting.
由于关于应由谁提供伦理咨询的争议日益增加，本研究调查了医生和临床伦理学家在道德推理和道德取向方面的差异。
从1987年至1990年，对来自美国各地14个州32个医疗中心的39名医生和50名临床医疗伦理学家（26名哲学家和24名神学家）进行了广泛访谈。访谈用于收集这89个人的选定人口统计学特征（年龄、性别和职业——医生或伦理学家），并确定他们的道德推理和道德取向得分。然后对人口统计学特征与道德推理和道德取向数据进行多系列相关分析和多变量分析。
在道德推理技能方面，无论是道德阶段得分（p <.01）还是加权平均得分（p <.01），医生的得分始终低于临床伦理学家。然而，在对正义或关怀的道德取向方面，医生在认可、主导或一致性方面与临床伦理学家没有显著差异（p <.05）。未发现年龄与道德取向之间存在显著关系。发现年龄与道德推理阶段之间存在显著关系，年龄较大的人得分较高。未发现性别与道德推理阶段之间存在显著关系。发现性别与道德取向之间存在显著关系：女性在道德困境中更有可能认识到关怀因素，而男性更有可能认识到正义因素。
本研究提供了初步证据，表明临床医疗伦理学家，无论是哲学家还是神学家，在进行伦理咨询方面可能比医生更有技能。就更高水平的道德推理与进行临床伦理咨询的卓越技能相关而言，本研究显示了将哲学家和神学家引入临床环境的价值。
