Lemiengre Joke, de Casterlé Bernadette Dierckx, Van Craen Katleen, Schotsmans Paul, Gastmans Chris
Center for Biomedical Ethics and Law, Faculty of Medicine, Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium.
Health Policy. 2007 Oct;83(2-3):131-43. doi: 10.1016/j.healthpol.2007.02.013. Epub 2007 Apr 12.
The responsibility of healthcare administrators for handling ethically sensitive medical practices, such as medical end-of-life decisions (MELDs), within an institutional setting has been receiving more attention. The overall aim of this paper is to thoroughly examine the prevalence, content, communication, and implementation of written institutional ethics policies on MELDs by means of a literature review.
Major databases (Pubmed, Cinahl, PsycINFO, Cochrane Library, FRANCIS, and Philosopher's Index) and reference lists were systematically searched for all relevant papers. Inclusion criteria for relevance were that the study was empirically based and that it focused on the prevalence, content, communication, or implementation of written institutional ethics policies concerning MELDs.
Our search yielded 19 studies of American, Canadian, Dutch and Belgian origin. The majority of studies dealt with do-not-resuscitate (DNR) policies (prevalence: 10-89%). Only Dutch and Belgian studies dealt with policies on pain and symptom control (prevalence: 15-19%) and policies on euthanasia (prevalence: 30-79%). Procedural and technical aspects were a prime focus, while the defining of the specific roles of involved parties was unclear. Little attention was given to exploring ethical principles that question the ethical function of policies. In ethics policies on euthanasia, significant consideration was given to procedures that dealt with conscientious objections of physicians and nurses. Empirical studies about the implementation of ethics policies are scarce.
With regard to providing support for physicians and nurses, DNR and euthanasia policies expressed support by primarily providing technical and procedural guidelines. Further research is needed whether and in which way written institutional ethics policies on MELDs could contribute to better end-of-life care.
医疗机构管理人员在机构环境中处理诸如医疗临终决策（MELDs）等伦理敏感医疗行为的责任已受到更多关注。本文的总体目标是通过文献综述，全面审视关于MELDs的书面机构伦理政策的普遍性、内容、沟通及实施情况。
系统检索主要数据库（PubMed、Cinahl、PsycINFO、Cochrane图书馆、FRANCIS和哲学家索引）及参考文献列表，查找所有相关论文。相关性的纳入标准为该研究基于实证，且聚焦于关于MELDs的书面机构伦理政策的普遍性、内容、沟通或实施情况。
我们的检索得到了19项源自美国、加拿大、荷兰和比利时的研究。大多数研究涉及不进行心肺复苏（DNR）政策（普遍性：10 - 89%）。只有荷兰和比利时的研究涉及疼痛和症状控制政策（普遍性：15 - 19%）以及安乐死政策（普遍性：30 - 79%）。程序和技术方面是主要关注点，而相关各方具体角色的界定并不明确。对质疑政策伦理功能的伦理原则探讨较少。在安乐死伦理政策中，对处理医生和护士出于良心拒行的程序给予了大量关注。关于伦理政策实施的实证研究稀缺。
在为医生和护士提供支持方面，DNR和安乐死政策主要通过提供技术和程序指南来表达支持。关于MELDs的书面机构伦理政策是否以及以何种方式能有助于改善临终护理，还需要进一步研究。
