Guevara-López Uría, Altamirano-Bustamante Myriam M, Viesca-Treviño Carlos
Facultad de Medicina y Cirugía de la Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, Mexico.
Centro Interdisciplinario para el Estudio y Tratamiento del Dolor y Cuidados Paliativos del UMAE "Dr. Victorio de la Fuente Narvaez", México, DF, Mexico.
BMC Med Ethics. 2015 Feb 26;16:11. doi: 10.1186/s12910-015-0003-2.
In our time there is growing interest in developing a systematic approach to oncologic patients and end-of-life care. An important goal within this domain is to identify the values and ethical norms that guide physicians' decisions and their recourse to technological aids to preserve life. Though crucial, this objective is not easy to achieve. The purpose of this study is to evaluate empirically the real-life bioethical dilemmas with which palliative physicians are confronted when treating terminal cancer patients.
A quasi-experimental, observational, comparative, prospective and mixed (qualitative and quantitative) study was conducted in order to analyse the correlation between the palliative doctor-patient relationship and ethical judgments regarding everyday bioethical dilemmas that arise in palliative clinical practice. The values at stake in decision-making on a daily basis were also explored. From February 2012 to march 2014, palliative healthcare personnel were invited to participate in a research project on axiology of clinical practice in palliative medicine. Each participant answered to a set of survey instruments focusing on ethical dilemmas, views, and representations of clinical practice. For this analysis we selected a convenience sample of 30 physicians specialized in pain medicine and palliative care (algologists and palliativists), with two or more years of experience with oncologic patients and end-of-life care.
113 dilemmas were obtained, the most frequent of which were those regarding sedation, home administration of opioids, and institutional regulations. We observed that the ethical nucleus of palliative medicine is truth-telling, implying bidirectional trust between patients and healthcare providers. The two most prominent virtues among the participants in our study were justice and professional humility. The outstanding roles of the physician in palliative medicine are as educator and as adviser, followed by that of provider of medical assistance.
This investigation opens up new horizons in a career path where professional wearing is rampant. The rediscovery of values and virtues in palliative clinical practice will renew and replenish the motivation of healthcare providers who carry out these duties, giving them a new professional and personal perspective of growth.
在我们这个时代，人们越来越关注为肿瘤患者和临终关怀制定一种系统的方法。这一领域的一个重要目标是确定指导医生决策以及他们借助技术手段维持生命的价值观和伦理规范。尽管这一目标至关重要，但却并非易事。本研究的目的是通过实证评估姑息治疗医生在治疗晚期癌症患者时所面临的现实生活中的生物伦理困境。
开展了一项准实验性、观察性、比较性、前瞻性的混合（定性和定量）研究，以分析姑息治疗医患关系与姑息临床实践中日常生物伦理困境的伦理判断之间的相关性。同时还探讨了日常决策中所涉及的价值观。2012年2月至2014年3月，邀请姑息治疗医护人员参与一项关于姑息医学临床实践价值论的研究项目。每位参与者都回答了一组侧重于伦理困境、临床实践观点和表象的调查工具。为进行此次分析，我们选取了30名专门从事疼痛医学和姑息治疗的医生（疼痛科医生和姑息治疗医生）作为便利样本，他们在肿瘤患者和临终关怀方面有两年或以上的经验。
共获得113个困境，其中最常见的是关于镇静、在家使用阿片类药物以及机构规定的困境。我们观察到，姑息医学的伦理核心是讲真话，这意味着患者与医护人员之间的双向信任。我们研究中的参与者所展现出的两个最突出的美德是公正和职业谦逊。姑息医学中医生的突出角色是教育者和顾问，其次才是医疗援助提供者。
这项调查为一个职业倦怠猖獗的职业道路开辟了新视野。在姑息临床实践中重新发现价值观和美德将更新并补充履行这些职责医护人员的动力，为他们提供一个新的职业和个人成长视角。
