Green M J, Mitchell G, Stocking C B, Cassel C K, Siegler M
MacLean Center for Clinical Medical Ethics, University of Chicago, Ill, USA.
Arch Intern Med. 1996 Feb 12;156(3):298-304.
To assess the extent to which actions reported by internal medicine trainees conflict with published guidelines on ethics.
A confidential survey was sent to a random sample (N = 1000) of associate members of the American College of Physicians (ACP). Questions were asked about ethical decision making in areas addressed by the guidelines in the ACP Ethics Manual. Quoted manual guidelines were provided, followed by 55 yes or no questions, such that a yes answer represented an action that conflicted with a guideline. There were two follow-up mailings to nonresponders.
Forty percent (n = 397) completed the questionnaire; 17% indicated they were aware of the guidelines on ethics. On average, associates responded yes to 16% of questions where a yes response indicated they have acted outside guidelines on ethics one or more times. The mean number of responses (n = 55) that conflicted with a guideline was 7.6 per person (SD, 4.7 responses; range, 0 to 33 responses). Ninety-eight percent of respondents reported actions falling outside a guideline one or more times and 80% did so four or more times. The most frequently reported reason (965/3219 [30%]) from a list of four choices for acting outside a guideline was "I was aware of the guideline, but this did not represent an ethical dilemma to me."
Few responding ACP associates indicated awareness of the ACP guidelines on ethics. Physicians in training nevertheless reported acting according to the presented guidelines most of the time, although nearly all respondents acted outside a guideline at least once, and some did so many times. Reported behaviors were sometimes inconsistent with consensus ethical standards that apply to internists. Physicians in training need to know more about ethical standards that apply to their own practice and should be aware when their actions deviate from ethical norms. Before acting outside guidelines on ethics, trainees should discuss their conflicts with others, such as attending physicians, clinical ethicists, or hospital ethics committees.
评估内科实习医生报告的行为与已发表的伦理准则冲突的程度。
向美国医师协会（ACP）准会员的随机样本（N = 1000）发送了一份保密调查问卷。询问了关于ACP伦理手册中准则所涉及领域的伦理决策问题。提供了手册中的引用准则，随后是55个是或否的问题，回答“是”表示该行为与准则冲突。对未回复者进行了两次跟进邮寄。
40%（n = 397）完成了问卷；17%表示他们知晓伦理准则。平均而言，准会员对16%的问题回答“是”，回答“是”表明他们曾一次或多次做出违反伦理准则的行为。与准则冲突的回答平均数（n = 55）为每人7.6个（标准差，4.7个回答；范围，0至33个回答）。98%的受访者报告曾一次或多次做出违反准则的行为，80%的受访者这样做过四次或更多次。在列出的违反准则行为的四个选择原因中，最常被报告的原因（965/3219 [30%]）是“我知晓该准则，但这对我来说不构成伦理困境”。
很少有回复的ACP准会员表示知晓ACP伦理准则。然而，接受培训的医生报告称，他们大多数时候是按照所提供的准则行事的，尽管几乎所有受访者都至少有一次做出了违反准则的行为，有些受访者还多次这样做。报告的行为有时与适用于内科医生的共识性伦理标准不一致。接受培训的医生需要更多地了解适用于他们自身执业的伦理标准，并且应该意识到他们的行为何时偏离了伦理规范。在做出违反伦理准则的行为之前，实习生应该与他人讨论他们的冲突，比如主治医生、临床伦理学家或医院伦理委员会。
