Marcus Brian S, Shank Gary, Carlson Jestin N, Venkat Arvind
Yale University School of Medicine, New Haven, CT, USA.
HEC Forum. 2015 Mar;27(1):11-34. doi: 10.1007/s10730-014-9258-0.
Ethics consultation is a commonly applied mechanism to address clinical ethical dilemmas. However, there is little information on the viewpoints of health care providers towards the relevance of ethics committees and appropriate application of ethics consultation in clinical practice. We sought to use qualitative methodology to evaluate free-text responses to a case-based survey to identify thematically the views of health care professionals towards the role of ethics committees in resolving clinical ethical dilemmas. Using an iterative and reflexive model we identified themes that health care providers support a role for ethics committees and hospitals in resolving clinical ethical dilemmas, that the role should be one of mediation, rather than prescription, but that ultimately legal exposure was dispositive compared to ethical theory. The identified theme of legal fears suggests that the mediation role of ethics committees is viewed by health care professionals primarily as a practical means to avoid more worrisome medico-legal conflict.
伦理咨询是解决临床伦理困境的一种常用机制。然而,关于医疗保健提供者对伦理委员会的相关性以及伦理咨询在临床实践中的适当应用的观点,相关信息很少。我们试图采用定性方法来评估对基于案例的调查的自由文本回复,以便从主题上确定医疗保健专业人员对伦理委员会在解决临床伦理困境中的作用的看法。通过使用迭代和反思模型,我们确定了一些主题,即医疗保健提供者支持伦理委员会和医院在解决临床伦理困境中发挥作用,该作用应该是调解而非规定,但最终与伦理理论相比,法律风险起决定性作用。所确定的法律恐惧主题表明,医疗保健专业人员主要将伦理委员会的调解作用视为避免更令人担忧的医疗法律冲突的一种实际手段。