MacKenzie C Ronald, Meltzer Michele, Kitsis Elizabeth A, Mancuso Carol A
Hospital for Special Surgery, New York, New York.
Arthritis Rheum. 2013 Oct;65(10):2524-32. doi: 10.1002/art.38077.
Despite the frequency of ethical issues arising in patient care, ethical discourse in the rheumatology literature is negligible. To better understand the scope of ethical problems occurring in our specialty, the American College of Rheumatology (ACR) Committee on Ethics and Conflict of Interest surveyed ACR members. Specific objectives of the survey were 1) to learn the perceived frequency of ethical issues in rheumatology, 2) to identify activities that pose ethical problems in rheumatologic practice, 3) to determine the extent of education on, and self-perceived knowledge about, ethics among ACR members, and 4) to determine member interest in, and suggest content for, future ACR-sponsored educational activities related to bioethics.
The survey included 12 non-open-ended questions addressing 5 core areas: 1) ethical dilemmas in daily practice, 2) ethical concerns in basic and clinical research, 3) influence of industry, 4) ethics of regulatory policies, potential conflicts, and disclosure, and 5) personal education on and interest in ethics. Two open-ended questions were also included, asking respondents to list the ethical issues most relevant to rheumatology and to provide any comments. Data analysis was descriptive.
Seven hundred seventy-one responses were received. Respondents believed that ethical issues arise most frequently in practice and in clinical research. The most common ethical issues cited were the high cost of treatment for patients (51% of respondents) and for society (48%), and the practice of defensive medicine (45%).
The survey results suggest that ethical problems in rheumatology are of concern to the ACR membership. Further, there is a perceived need for educational programs targeted at helping members address such professional challenges.
尽管患者护理中出现伦理问题的频率很高，但风湿病学文献中的伦理讨论却少之又少。为了更好地了解我们专业中出现的伦理问题的范围，美国风湿病学会（ACR）伦理与利益冲突委员会对ACR成员进行了调查。该调查的具体目标是：1）了解风湿病学中伦理问题的感知频率；2）确定在风湿病学实践中引发伦理问题的活动；3）确定ACR成员中关于伦理的教育程度以及自我感知的伦理知识；4）确定成员对未来ACR主办的与生物伦理相关的教育活动的兴趣，并提出活动内容建议。
该调查包括12个非开放式问题，涉及5个核心领域：1）日常实践中的伦理困境；2）基础和临床研究中的伦理问题；3）行业影响；4）监管政策、潜在冲突及披露的伦理问题；5）个人对伦理的教育及兴趣。还包括两个开放式问题，要求受访者列出与风湿病学最相关的伦理问题并发表任何意见。数据分析采用描述性方法。
共收到771份回复。受访者认为伦理问题在实践和临床研究中出现的频率最高。最常被提及的伦理问题是患者治疗费用高昂（51%的受访者）和社会治疗费用高昂（48%），以及防御性医疗行为（45%）。
调查结果表明，ACR成员关注风湿病学中的伦理问题。此外，人们认为需要开展有针对性的教育项目，以帮助成员应对此类专业挑战。
