Bernthal Elizabeth M, Draper H J A, Henning J, Kelly J C
Academic Department of Military Nursing, Royal Centre for Defence Medicine (Academia and Research) Medical Directorate, Birmingham, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
J R Army Med Corps. 2017 Jun;163(3):199-205. doi: 10.1136/jramc-2016-000701. Epub 2016 Oct 25.
To identify and explore features of ethical issues that senior clinicians faced as deployed medical directors (DMDs) to the British Field Hospital in Afghanistan as well as to determine the ethical training requirements for future deployments.
A qualitative study in two phases conducted from November 2014 to June 2015. Phase 1 analysed 60 vignettes of cases that had generated ethical dilemmas for DMDs. Phase 2 included focus groups and an interview with 13 DMDs.
Phase 1 identified working with limited resources, dual conflict of meeting both clinical and military obligations and consent of children as the most prevalent ethical challenges. Themes found in Phase 2 included sharing clinical responsibilities with clinicians from other countries and not knowing team members' ways of working, in addition to the themes from Phase 1.
This study has drawn together examples of scenarios to form a repository that will aid future training. Recommendations included undertaking ethics training together as a team before, during and after deployment which must include all nationalities who are assigned to the same operational tour, so that different ethical views can be explored beforehand.
识别并探究资深临床医生作为驻阿富汗英国野战医院的部署医疗主任（DMD）时所面临的伦理问题特征，并确定未来部署的伦理培训要求。
于2014年11月至2015年6月分两个阶段进行的一项定性研究。第一阶段分析了60个给DMD带来伦理困境的病例 vignettes。第二阶段包括焦点小组讨论以及对13名DMD的访谈。
第一阶段确定了资源有限情况下的工作、履行临床和军事义务的双重冲突以及儿童同意问题是最普遍的伦理挑战。第二阶段发现的主题除了第一阶段的主题外，还包括与来自其他国家的临床医生分担临床责任以及不了解团队成员的工作方式。
本研究汇集了各种场景示例以形成一个资料库，这将有助于未来的培训。建议包括在部署前、部署期间和部署后作为一个团队共同进行伦理培训，培训必须涵盖被分配到同一行动任务的所有国籍人员，以便提前探讨不同的伦理观点。
