Meslin E M, Lemieux-Charles L, Wortley J T
National Center for Human Genome Research, National Institutes of Health, Bethesda, MD, USA.
Hosp Health Serv Adm. 1997 Spring;42(1):33-48.
In response to continued pressure on the Canadian healthcare system, hospitals are implementing structural changes to address issues of cost containment, utilization, and resource allocation. One strategy has been to decentralize managerial decision making to clinicians, creating "clinician-managers" (CMs). We surveyed 3,000 hospital-based CMs in Ontario, Canada (including physicians, nurses, and other health professionals), in order to understand the nature and frequency of the ethical issues they face as a consequence of their involvement in resource allocation decisions, and to identify mechanisms for dealing with these problems in their hospitals. Based on the survey results, we developed a Management Ethics Framework to assist CMs to reach an ethically justifiable resolution of these types of problems, both individually, and in the context of their membership in the healthcare team. The results, and particularly the discussion that follows, represent a confluence of philosophical, clinical, and organizational perspective on ethics and resource allocation by clinicians.
为应对加拿大医疗保健系统持续面临的压力，医院正在进行结构调整，以解决成本控制、利用率和资源分配等问题。其中一项策略是将管理决策权下放给临床医生，打造“临床医生管理者”（CMs）。我们对加拿大安大略省3000名医院CMs（包括医生、护士和其他卫生专业人员）进行了调查，以了解他们因参与资源分配决策而面临的伦理问题的性质和频率，并确定在其医院处理这些问题的机制。基于调查结果，我们制定了一个管理伦理框架，以帮助CMs在个人层面以及作为医疗团队成员的背景下，从伦理角度合理解决这类问题。这些结果，尤其是后续的讨论，代表了从哲学、临床和组织角度对临床医生的伦理与资源分配问题的融合看法。
