Clinical Ethical Dilemmas: Convergent and Divergent Views of Two Scholarly Communities
Journal of Medical Ethics 2006 July; 32(7): 381-388
OBJECTIVE: To survey members of the American Society for Bioethics and Humanities (ASBH; n = 327) and of the Society for Medical Decision Making (SMDM; n = 77) to elicit the similarities and differences in their reasoning about two clinical cases that involved ethical dilemmas. Cases: Case 1 was that of a patient refusing treatment that a surgeon thought would be beneficial. Case 2 dealt with end-of-life care. The argument was whether intensive treatment should be continued of an unconscious patient with multiorgan failure. Method: Four questions, with structured multiple alternatives, were asked about each case: identified core problems, needed additional information, appropriate next steps and who the decision maker should be. Observations and RESULTS: Substantial similarities were noticed between the two groups in identifying the core problems, the information needed and the appropriate next steps. SMDM members gave more weight to outcomes and trade-offs and ASBH members had patient autonomy trump other considerations more strongly. In case 1, more than 60% of ASBH respondents identified the patient alone as the decision maker, whereas members of SMDM were almost evenly divided between having the patient as the solo decision maker or preferring a group of some sort as the decision maker, a significant difference (p
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Ideals of Patient Autonomy in Clinical Decision Making: A Study on the Development of a Scale to Assess Patients' and Physicians' Views Stiggelbout, A.M.; Molewijk, A.C.; Otten, W.; Timmermans, D.R.M.; van Bockel, J.H.; Kievit, J. (2004-06)OBJECTIVES: Evidence based patient choice seems based on a strong liberal individualist interpretation of patient autonomy; however, not all patients are in favour of such an interpretation. The authors wished to assess ...