Bahus Marianne K, Førde Reidun
School of Business and Law, Department of Law, University of Agder, Kristiansand, Norway.
Faculty of Medicine, Centre for Medical Ethics, Institute of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
HEC Forum. 2016 Sep;28(3):261-72. doi: 10.1007/s10730-015-9296-2.
With disagreement, doubts, or ambiguous grounds in end-of-life decisions, doctors are advised to involve a clinical ethics committee (CEC). However, little has been published on doctors' experiences with discussing an end-of-life decision in a CEC. As part of the quality assurance of this work, we wanted to find out if clinicians have benefited from discussing end-of-life decisions in CECs and why. We will disseminate some Norwegian doctors' experiences when discussing end-of-life decisions in CECs, based on semi-structured interviews with fifteen Norwegian physicians who had brought an end-of-life decision case to a CEC. Almost half of the cases involved conflicts with the patients' relatives. In a majority of the cases, there was uncertainty about what would be the ethically preferable solution. Reasons for referring the case to the CEC were to get broader illumination of the case, to get perspective from people outside the team, to get advice, or to get moral backing on a decision already made. A great majority of the clinicians reported an overall positive experience with the CECs' discussions. In cases where there was conflict, the clinicians reported less satisfaction with the CECs' discussions. The study shows that most doctors who have used a CEC in an end-of-life decision find it useful to have ethical and/or legal aspects illuminated, and to have the dilemma scrutinized from a new perspective. A systematic discussion seems to be significant to the clinicians.
在临终决策中存在分歧、疑问或理由不明确时，建议医生寻求临床伦理委员会（CEC）的参与。然而，关于医生在临床伦理委员会中讨论临终决策的经历，相关报道甚少。作为这项工作质量保证的一部分，我们想了解临床医生是否从在临床伦理委员会中讨论临终决策中受益以及原因。我们将基于对15名曾将临终决策案例提交给临床伦理委员会的挪威医生进行的半结构化访谈，来传播一些挪威医生在临床伦理委员会中讨论临终决策的经历。几乎一半的案例涉及与患者亲属的冲突。在大多数案例中，对于什么是伦理上更可取的解决方案存在不确定性。将案例提交给临床伦理委员会的原因包括更全面地了解案例、从团队以外的人那里获取观点、获得建议，或者为已做出的决策寻求道德支持。绝大多数临床医生报告称对临床伦理委员会的讨论总体上有积极的体验。在存在冲突的案例中，临床医生对临床伦理委员会的讨论满意度较低。该研究表明，大多数在临终决策中使用过临床伦理委员会的医生发现，阐明伦理和/或法律方面的问题以及从新的角度审视困境是有用的。系统的讨论对临床医生似乎很重要。
