Lemieux-Charles L, Meslin E M, Aird C, Baker R, Leatt P
Department of Health Administration, University of Toronto, Ontario.
Hosp Health Serv Adm. 1993 Summer;38(2):267-85.
This article explores the ethical issues faced by clinicians with management responsibilities (clinician/managers) when making decisions related to resource allocation and utilization at a Canadian teaching hospital. Using a focus group method, 28 individuals participated in four homogeneous groups that included nurse managers, managers from other professional groups, and physician managers. Ethical issues that recurred throughout the discussions included fairness, concern with preventing harm, consumer/patient choice, balancing needs of different groups of patients, conflict between financial incentives and patient needs, and professional autonomy. The particular issue of conflict is analyzed from two perspectives--a theory of professional-bureaucratic roles and of obligation--that illustrate how both management and philosophical issues are related. The findings suggest that decentralizing resource allocation and utilization decisions does raise ethical issues for clinician/managers and that a better understanding of these issues can be obtained using an interdisciplinary perspective.
本文探讨了在加拿大一家教学医院，负有管理职责的临床医生（临床医生/管理者）在做出与资源分配和利用相关决策时所面临的伦理问题。采用焦点小组方法，28人参与了四个同类小组，其中包括护士长、其他专业组的管理者以及医生管理者。讨论中反复出现的伦理问题包括公平、预防伤害的关切、消费者/患者选择、平衡不同患者群体的需求、经济激励与患者需求之间的冲突以及职业自主性。从专业官僚角色理论和义务理论这两个视角对冲突这一特定问题进行了分析，这两个理论阐明了管理问题与哲学问题是如何相关的。研究结果表明，将资源分配和利用决策分散化确实会给临床医生/管理者带来伦理问题，并且使用跨学科视角能够更好地理解这些问题。
