Magelssen Morten, Gjerberg Elisabeth, Pedersen Reidar, Førde Reidun, Lillemoen Lillian
Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Pb. 1130 Blindern, N-0318, Oslo, Norway.
BMC Med Ethics. 2016 Nov 8;17(1):70. doi: 10.1186/s12910-016-0158-5.
Internationally, clinical ethics support has yet to be implemented systematically in community health and care services. A large-scale Norwegian project (2007-2015) attempted to increase ethical competence in community services through facilitating the implementation of ethics support activities in 241 Norwegian municipalities. The article describes the ethics project and the ethics activities that ensued.
The article first gives an account of the Norwegian ethics project. Then the results of two online questionnaires are reported, characterizing the scope, activities and organization of the ethics activities in the Norwegian municipalities and the ethical topics addressed.
One hundred and thirty-seven municipal contact persons answered the first survey (55 % response rate), whereas 217 ethics facilitators from 48 municipalities responded to the second (33 % response rate). The Norwegian ethics project is vast in scope, yet has focused on some institutions and professions (e.g., nursing homes, home-based care; nurses, nurses' aides, unskilled workers) whilst seldom reaching others (e.g., child and adolescent health care; physicians). Patients and next of kin were very seldom involved. Through the ethics project employees discussed many important ethical challenges, in particular related to patient autonomy, competence to consent, and cooperation with next of kin. The "ethics reflection group" was the most common venue for ethics deliberation.
The Norwegian project is the first of its kind and scope, and other countries may learn from the Norwegian experiences. Professionals have discussed central ethical dilemmas, the handling of which arguably makes a difference for patients/users and service quality. The study indicates that large (national) scale implementation of CES structures for the municipal health and care services is complex, yet feasible.
在国际上，临床伦理支持尚未在社区卫生和护理服务中得到系统实施。挪威的一个大型项目（2007 - 2015年）试图通过促进在241个挪威自治市开展伦理支持活动来提高社区服务中的伦理能力。本文描述了该伦理项目及随后开展的伦理活动。
本文首先介绍了挪威的伦理项目。然后报告了两份在线问卷的结果，这些结果描述了挪威自治市伦理活动的范围、活动和组织情况以及所涉及的伦理主题。
137名市政联系人回答了第一次调查（回复率为55%），而来自48个自治市的217名伦理促进者回复了第二次调查（回复率为33%）。挪威的伦理项目规模庞大，但侧重于一些机构和职业（如养老院、居家护理；护士、护工、非技术工人），而很少涉及其他机构和职业（如儿童和青少年保健；医生）。患者及其近亲很少参与其中。通过该伦理项目，员工们讨论了许多重要的伦理挑战，特别是与患者自主权、同意能力以及与近亲合作相关的挑战。“伦理反思小组”是最常见的伦理审议场所。
挪威的这个项目在同类项目中规模空前，其他国家或许可以借鉴挪威的经验。专业人员讨论了核心伦理困境，对这些困境的处理无疑会对患者/服务对象和服务质量产生影响。该研究表明，在市政卫生和护理服务中大规模（全国性）实施临床伦理支持结构虽然复杂，但却是可行的。
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