Pedersen R, Akre V, Førde R
Department of General Practice and Community Medicine, Section for Medical Ethics, University of Oslo, Oslo, Norway.
J Med Ethics. 2009 Mar;35(3):147-52. doi: 10.1136/jme.2008.026393.
Clinical ethics consultation services have been established in many countries during recent decades. An important task is to discuss concrete clinical cases. However, empirical research observing what is happening during such deliberations is scarce.
To explore clinical ethics committees' deliberations and to identify areas for improvement.
A pilot study including observations of committees deliberating a paper case, semistructured group interviews, and qualitative analysis of the data.
Nine hospital ethics committees in Norway.
Key elements of the deliberations included identifying the ethical problems; exploring moral values and principles; clarifying key concepts and relevant legal regulation; exploring medical facts, the patient's situation, the therapists' perspective, analogous clinical situations, professional uncertainties, the patient's and relatives' perspective, and clinical communication; identifying the involved parties and how to involve them; identifying possible courses of action, and possible conclusion and follow-up. The various elements were closely interwoven. The content and conclusions varied and seemed to be contingent on the committee members' interpretations, experience and knowledge. Important aspects of a clinical ethics deliberation were sometimes neglected. When the committees used a deliberation procedure and a blackboard, the deliberations tended to become more systematic and transparent. Many of the committees were insecure about how to include the involved parties and how to document the deliberations.
Clinical ethics committees may provide an important arena for multidisciplinary discussions of complex clinical ethics challenges. However, this seems to require adequate composition, adoption of transparent deliberation procedures, and targeted training.
近几十年来，许多国家都设立了临床伦理咨询服务。一项重要任务是讨论具体的临床案例。然而，观察此类审议过程中实际情况的实证研究却很匮乏。
探讨临床伦理委员会的审议情况，并确定改进领域。
一项试点研究，包括观察委员会对一个书面案例的审议、半结构化小组访谈以及对数据的定性分析。
挪威的九个医院伦理委员会。
审议的关键要素包括识别伦理问题；探讨道德价值观和原则；澄清关键概念和相关法律法规；探究医学事实、患者情况、治疗师的观点、类似临床情况、专业不确定性、患者及其亲属的观点以及临床沟通；确定相关方以及如何让他们参与；确定可能的行动方案、可能的结论及后续跟进。各个要素紧密交织。内容和结论各不相同，似乎取决于委员会成员的解读、经验和知识。临床伦理审议的重要方面有时会被忽视。当委员会采用审议程序并使用黑板时，审议往往会变得更加系统和透明。许多委员会在如何让相关方参与以及如何记录审议过程方面感到不确定。
临床伦理委员会可能为多学科讨论复杂的临床伦理挑战提供一个重要平台。然而，这似乎需要适当的人员构成、采用透明的审议程序以及有针对性的培训。
