Cognitive studies of ethical reasoning based on the KARDIO-simulator

Empirical investigations in medical ethics are often questionnaire studies relying on the respondents' written responses about their attitudes and actions. This approach is valuable, but there may be quite large discrepancies between responses and actual behaviour. Unfortunately actual behaviour is often difficult to observe, especially where sensitive or very time dependent clinical decisions are concerned. We have tried to circumvent this problem by using a micro-world computer simulation of a cardiac care unit to study treatment decisions in "life or death" situations. The task facing the physician in this simulation is to be in charge of a 6-bed cardiac care unit for a period of 14 "days" controlling admissions, discharges, and treatment of all patients. The simulation dynamically generates the disease states of the patients in the unit including physical findings, laboratory findings, ECG, X-ray descriptions etc., as well as the patients responses to treatment. The simulation also presents new patients from the emergency room, thereby forcing the physician to decide whether the new patient should be admitted, and whether one of the present patients should be discharged or moved to another ward if no bed is free. The paper describes this simulator, the mathematical model underlying the simulation of patients with acute myocardial infarction, and the results of the initial studies using the simulator.