An Ethical Fa？ade Medical Students Miscomprehensions of Substituted Judgment 英文参考文献.docVIP

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An Ethical Fa？ade Medical Students Miscomprehensions of Substituted Judgment 英文参考文献.doc

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An Ethical Fa？ade Medical Students Miscomprehensions of Substituted Judgment 英文参考文献

AnEthicalFac?ade? MedicalStudents’ MiscomprehensionsofSubstitutedJudgment FarrA.Curlin1,2*,RyanE.Lawrence3,JulieFredrickson4 1SectionofGeneralInternalMedicine,DepartmentofMedicine,UniversityofChicago,Chicago,Illinois,UnitedStatesofAmerica,2MacLeanCenterforClinicalMedical Ethics,UniversityofChicago,Chicago,Illinois,UnitedStatesofAmerica,3PritzkerSchoolofMedicine,UniversityofChicago,Chicago,Illinois,UnitedStatesofAmerica, 4TheUndergraduateCollege,UniversityofChicago,Chicago,Illinois,UnitedStatesofAmerica Abstract Background:Westudiedhowwellfirst-yearmedicalstudentsunderstandandapplytheconceptofsubstitutedjudgment, followingacourseonclinicalethics. Method: Students submitted essays on one of three ethically controversial scenarios presented in class. One scenario involvedapatientwhohadlostdecisionalcapacity.Throughaniterativeprocessoftextualanalysis,theessayswerestudied andcodedforpatternsinthewaysstudentsmisunderstoodormisappliedtheprincipleofsubstitutedjudgment. Results: Students correctly articulated course principles regarding patient autonomy, substituted judgment, and non- imposition of physician values. However, students showed misunderstanding by giving doctors the responsibility of balancingtheinterestsofthepatientagainsttheinterestsofthefamily,bystatingdoctorsandsurrogatesshouldbeguided primarilybyabest-intereststandard,andbysuggestingthatpatientautonomybecomestheguidingprincipleonlywhen patientscannolongerexpresstheirwishes. Conclusion:Studentsdidnotappeartointernalizeorcorrectlyapplythesubstitutedjudgmentstandard,eventhoughthey coulddescribeitaccurately.Thissuggeststhesubstitutedjudgmentstandardmayruncountertostudents’moralintuitions, makingithardertoapplyinclinicalpractice. Citation:CurlinFA,LawrenceRE,FredricksonJ(2009)AnEthicalFac?ade?MedicalStudents’MiscomprehensionsofSubstitutedJudgment.PLoSONE4(2):e4374. doi:10.1371/journal.pone.0004374 Editor:ErikvonElm,UniversityofBern,Switzerland ReceivedAugust26,2008;AcceptedDecember9,2008;PublishedFebruary4,20