A qualitative investigation of selecting surrogate decision-makers.
A qualitative investigation of selecting surrogate decision-makers.
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选择代理决策者的定性调查。
DOI：
10.1136/jme.2010.037978
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发表时间：
2011
影响因子：
4.1
通讯作者：
Edwards SJ
中科院分区：
文献类型：
--
作者：
Edwards SJ
背景：关于代理人决策的实证研究倾向于假设代理人只应该做出“替代判断”——也就是说，判断如果病人有精神能力的话，他们会想要什么。目的探讨人们对他们自己选择的代理决策者的期望，并检验人们希望他们选择的代理人只做出替代判断的假设。方法招募30名大学生。研究人员向他们展示了一个关于他们未来预期会失去智力的假设场景，并要求他们回答一些关于他们选择代理人的问题。使用主题内容分析对这些数据进行定性分析。结果大多数受访者表示，他们会选择一个在某些方面有爱心、有能力的人，并为他们的判断提供有趣的证据。令人惊讶的是，很少有人强调他们认为自己选择的代孕母亲非常了解自己的喜好，并且能够做出替代判断。此外，很少有人明确指出，他们所选择的代理人与他们自己有类似的态度和价值观，因此在目前的情况下会做出与他们类似的决定。一些受访者还提到他们所选择的代理人的社会角色或他们所处环境的社会动态影响了他们的选择，以及互惠的观念和诚实和忠诚的特征。结论：如果他们失去了心智能力，许多人不会仅仅因为他们希望他们的代理人做出替代判断而选择代理人来代表他们决定医疗。
BackgroundEmpirical studies of surrogate decision-making tend to assume that surrogates should make only a 'substituted judgement'—that is, judge what the patient would want if they were mentally competent.ObjectivesTo explore what people want in a surrogate decision-maker whom they themselves select and to test the assumption that people want their chosen surrogate to make only a substituted judgement.Methods30 undergraduate students were recruited. They were presented with a hypothetical scenario about their expected loss of mental capacity in the future and asked to answer some questions about their choice of surrogate. These data were analysed qualitatively using thematic content analysis.ResultsMost respondents talked about choosing someone who was caring and competent in certain ways, giving interesting evidence for their judgements. Surprisingly few highlighted how well they thought their chosen surrogate knew their preferences and would be able to make a substituted judgement. Moreover, few specified that their chosen surrogate had similar attitudes and values to their own and so would make a similar decision to theirs in the circumstances presented. Some respondents also referred to the social role of their chosen surrogate or the social dynamics of their situation which influenced their choices, as well as to ideas of reciprocity and characteristics of honesty and loyalty.ConclusionIn the event that they lose mental capacity, many people will not select a surrogate to decide about medical treatments on their behalf solely on the basis that they expect their surrogate to make a substituted judgement.