By-Person Factor Analysis in Clinical Ethical Decision Making: Q Methodology in End-of-Life Care Decisions
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Ezio Di Nucci
Jack Alan Reynolds
Learn more about PhilPapers
American Journal of Bioethics 4 (3):W8-W22 (2004)
Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues. Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix. Setting: University medical center. Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center. Interventions: Presented with four hypothetical cases involving urgent decision making near the end of life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases. Measurements and Main Results: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r 2 < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study. Conclusions: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies
|Keywords||No keywords specified (fix it)|
|Categories||categorize this paper)|
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
|Through your library|
References found in this work BETA
Albert R. Jonsen & Stephen Toulmin (1991). The Abuse of Casuistry: A History of Moral Reasoning. Philosophy and Rhetoric 24 (1):76-80.
Terry M. Perlin (1992). Clinical Medical Ethics Cases in Practice. Monograph Collection (Matt - Pseudo).
Citations of this work BETA
No citations found.
Similar books and articles
Stephen G. Pauker (1984). Decision Analysis as a Basis for Medical Decision Making: The Tree of Hippocrates. Journal of Medicine and Philosophy 9 (2):181-214.
Hanne Irene Jensen, Jette Ammentorp, Helle Johannessen & Helle Ørding (2013). Challenges in End-of-Life Decisions in the Intensive Care Unit: An Ethical Perspective. [REVIEW] Journal of Bioethical Inquiry 10 (1):93-101.
Donnie J. Self (1983). A Study of the Foundations of Ethical Decision-Making of Physicians. Theoretical Medicine and Bioethics 4 (1).
Donnie J. Self & Joy D. Skeel (1991). A Study of the Foundations of Ethical Decision Making of Clinical Medical Ethicists. Theoretical Medicine and Bioethics 12 (2).
Gretchen B. Chapman & Frank A. Sonnenberg (eds.) (2000). Decision Making in Health Care: Theory, Psychology, and Applications. Cambridge University Press.
Alan Schwartz (2008). Medical Decision Making: A Physician's Guide. Cambridge University Press.
John Mark Freeman (1987). Tough Decisions: A Casebook in Medical Ethics. Oxford University Press.
Greg Clarke, Robert T. Hall & Greg Rosencrance (2004). Physician-Patient Relations: No More Models. American Journal of Bioethics 4 (2):16 – 19.
Rosa Lynn Pinkus (1981). Medical Foundations of Various Approaches to Medical-Ethical Decision-Making. Journal of Medicine and Philosophy 6 (3):295-308.
Arthur R. Derse (1999). Making Decisions About Life-Sustaining Medical Treatment in Patients with Dementia. Theoretical Medicine and Bioethics 20 (1):55-67.
Richard W. Momeyer (1983). Medical Decisions Concerning Noncompetent Patients. Theoretical Medicine and Bioethics 4 (3).
Seiji Bito & Atsushi Asai (2007). Attitudes and Behaviors of Japanese Physicians Concerning Withholding and Withdrawal of Life-Sustaining Treatment for End-of-Life Patients: Results From an Internet Survey. BMC Medical Ethics 8 (1):1-9.
Baruch A. Brody (1988). Life and Death Decision Making. Oxford University Press.
Barbara Libby & Vincent Agnello (2000). Ethical Decision Making and the Law. Journal of Business Ethics 26 (3):223 - 232.
Lars Sandman & Christian Munthe (2009). Shared Decision-Making and Patient Autonomy. Theoretical Medicine and Bioethics 30 (4):289-310.
Added to index2010-09-14
Total downloads10 ( #313,434 of 1,789,858 )
Recent downloads (6 months)1 ( #423,018 of 1,789,858 )
How can I increase my downloads?