Aleksandrova Silviya
Department of Social and Preventive Medicine, Faculty of Public Health, University of Medicine, Pleven, Bulgaria.
Med Health Care Philos. 2008 Mar;11(1):35-42. doi: 10.1007/s11019-007-9100-4. Epub 2007 Oct 2.
Contemporary medical practice is complicated by many dilemmas requiring ethical sensitivity and moral reasoning.
To investigate physicians' experience in ethical decision-making and their attitude towards ethics consultation.
In a cross-sectional survey 126 physicians representing the main clinics of Pleven University hospital were investigated by a self-administered questionnaire. The following variables were measured: occurrence, nature and ways of resolving ethical problems; physicians' attitudes towards ethics consultation; physicians' opinions on qualities and skills of an ethics consultant, and socio-demographic characteristics. Data analysis included descriptive statistics, chi(2 )and t-test.
Response rate was 88.9% (n = 112). Men and women were equally represented (48.2%-51.8%). The sample consisted of experienced physicians: 42.9% had 11-20 years experience, and 33% had 21-30 years. According to 84.8% of respondents, ethical problems have been discussed in their specialty. Predominant dilemmas included relationships with patients and relatives (76.8%) and team work (67.6%). Over (3/4) of physicians needed an advice in solving ethical problems. Ninety six percent responded positively to ethics consultation. They would mainly request it for resolving conflicts (72.5%), and in case of concern for the rightness of their decisions (52.7%). The image of an ethics consultant was built of clinical competence (70.9%), ability to deal with conflicts (59.1%), communication skills (58.2%), tolerance for different views (55.4%), and a special qualification in ethics (52.7%).
The study underlined that Pleven University hospital physicians face similar ethical dilemmas as their colleagues in other countries do. The expressed positive attitudes to ethics consultation should serve as a basis for further research and development of ethics consultation services.
当代医疗实践因诸多困境而变得复杂，这些困境需要伦理敏感性和道德推理。
调查医生在伦理决策方面的经历以及他们对伦理咨询的态度。
在一项横断面调查中，采用自填式问卷对代表普列文大学医院主要科室的126名医生进行了调查。测量了以下变量：伦理问题的发生情况、性质和解决方式；医生对伦理咨询的态度；医生对伦理顾问素质和技能的看法，以及社会人口学特征。数据分析包括描述性统计、卡方检验和t检验。
回复率为88.9%（n = 112）。男女比例相当（48.2% - 51.8%）。样本由经验丰富的医生组成：42.9%有11 - 20年工作经验，33%有21 - 30年工作经验。据84.8%的受访者称，他们所在专业领域讨论过伦理问题。主要困境包括与患者及亲属的关系（76.8%）和团队合作（67.6%）。超过四分之三的医生在解决伦理问题时需要建议。96%的人对伦理咨询给予肯定回应。他们主要会因解决冲突（72.5%）以及担心自身决策的正确性（52.7%）而寻求伦理咨询。伦理顾问的形象由临床能力（70.9%）、处理冲突的能力（59.1%）、沟通技巧（58.2%）、对不同观点的包容度（55.4%）以及伦理学方面的专业资质（52.7%）构成。
该研究强调，普列文大学医院的医生面临着与其他国家同行类似的伦理困境。对伦理咨询所表达的积极态度应为伦理咨询服务的进一步研究和发展提供基础。
