Silva D S, Gibson J L, Sibbald R, Connolly E, Singer P A
University of Toronto Joint Centre for Bioethics, 88 College St, Toronto, Ontario M5G1L4, Canada.
J Med Ethics. 2008 May;34(5):320-3. doi: 10.1136/jme.2007.020891.
Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature.
To describe clinical ethicists' perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues.
Qualitative case study involving semi-structured interviews with 18 clinical ethicists across 13 health organisations in Toronto, Canada.
From the clinical ethicists' perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation's moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support.
Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education.
卫生组织对组织伦理能力的需求日益增长，尤其是在管理人员中。临床伦理学家在组织伦理中的角色以及他们对组织伦理的看法，在文献中尚未得到充分描述或记录。
描述临床伦理学家对其所在医院组织伦理问题的看法、他们在组织伦理方面的机构角色，以及他们在帮助解决组织伦理问题方面的感知效果。
定性案例研究，涉及对加拿大多伦多13个卫生组织的18名临床伦理学家进行半结构化访谈。
从临床伦理学家的角度来看，他们所在组织中最紧迫的组织伦理问题是：资源分配、与组织道德氛围相关的员工道德困扰、利益冲突以及具有重大组织层面的临床问题。临床伦理学家尤其就与员工道德困扰和具有组织层面的临床问题相关的问题接受咨询。一些伦理学家表示，在资源分配、利益冲突和其他公司决策方面，他们越来越多地被咨询。许多临床伦理学家感到，他们缺乏对组织决策过程的足够了解、组织伦理方面的培训，以及获取组织伦理工具的途径，难以有效应对组织伦理支持需求的不断增加。
医疗机构对组织伦理专业知识的需求不断增长，正在重塑临床伦理学家的角色。在组织伦理方面的有效性需要重新评估临床伦理培训，将组织伦理和组织决策过程中的能力建设纳入其中，作为对传统临床伦理教育的补充。
