Centre for Ethics and Law in the Life Sciences (CELLS), Institut für Geschichte, Ethik und Philosophie der Medizin, Medizinische Hochschule Hannover, Carl-Neuberg Strasse 1, Hannover, Germany.
J Med Ethics. 2011 Jul;37(7):390-6. doi: 10.1136/jme.2010.040121. Epub 2011 Feb 22.
While there are many guidelines on how to make ethical decisions at the end of life, there is little evidence regarding the quality of this sort of ethical guidelines.
First, this study aims to demonstrate the conceptual transferability of the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument for the quality assessment of ethical guidelines. Second, it aims to illustrate the status quo of the quality of guidelines on end-of-life decision-making by using the AGREE instrument in a first practice test.
The transferability of the AGREE instrument on the quality assessment of ethical guidelines is demonstrated by conceptual analysis. Guidelines on end-of-life decisions in medicine are identified through a systematic search in MEDLINE (from June 1999 to June 2009). The quality of all included guidelines was assessed with a slightly modified AGREE instrument.
Of 103 guidelines identified, 34 were included as relevant. The majority of the guidelines analysed in this study were assessed as qualitatively insufficient in five out of six AGREE quality domains. A few guidelines demonstrated, however, that a high level of quality in accordance with the AGREE requirements is possible.
This review concludes that the quality of many ethical guidelines should and can be improved in all quality domains specified by the AGREE instrument. Furthermore, conceptual analysis indicates that a slightly modified AGREE instrument is transferable to the comprehensive evaluation of the quality of ethical guidelines. Nevertheless, future research is needed to improve the assessment of the presentation of the guidelines' normative basis.
尽管有许多关于如何在生命末期做出伦理决策的指南，但关于此类伦理指南质量的证据却很少。
首先，本研究旨在证明 Appraisal of Guidelines for Research and Evaluation（AGREE）工具在评估生命末期决策伦理指南质量方面的概念可转移性。其次，它旨在通过在首次实践测试中使用 AGREE 工具来说明生命末期决策指南质量的现状。
通过概念分析来证明 AGREE 工具在评估生命末期决策伦理指南质量方面的概念可转移性。通过在 MEDLINE（1999 年 6 月至 2009 年 6 月）中进行系统搜索来确定医学中有关生命末期决策的指南。使用经过略微修改的 AGREE 工具评估所有纳入指南的质量。
在确定的 103 条指南中，有 34 条被认为与本研究相关。在本研究中分析的大多数指南在六个 AGREE 质量领域中的五个领域被评估为定性不足。然而，一些指南表明，根据 AGREE 要求达到高质量是可能的。
本综述得出的结论是，许多伦理指南的质量应该并且可以在 AGREE 工具规定的所有质量领域中得到提高。此外，概念分析表明，经过略微修改的 AGREE 工具可以转移到对伦理指南质量的全面评估上。然而，未来仍需要研究来提高对指南规范基础的呈现进行评估。
