Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark; Department of Obstetrics and Gynaecology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark.
Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark.
Soc Sci Med. 2017 Mar;176:14-20. doi: 10.1016/j.socscimed.2017.01.017. Epub 2017 Jan 16.
When a life is lost or severely impaired during childbirth, the midwife and obstetrician involved may experience feelings of guilt in the aftermath. Through three empirical cases, the paper examines the sense of guilt in the context of the current patient safety culture in healthcare where a blame-free approach is promoted in the aftermath of adverse events. The purpose is to illustrate how healthcare professionals may experience guilt without being at fault after adverse events, and Gamlund's theory on forgiveness without blame is used as the theoretical framework for this analysis. Philosophical insight has proven to be a useful resource in dealing with psychological issues of guilt and Gamlund's view on error and forgiveness elucidates an interesting dilemma in the field of traumatic events and medical harm in healthcare, where healthcare professionals experience that well-intended actions may cause injury, harm or even death to their patients. Failing to recognise and acknowledge guilt or guilty feelings may preclude self-forgiveness, which could have a negative impact on the recovery of midwives and obstetricians after adverse events. Developing and improving support systems for healthcare professionals is a multi-factorial task, and the authors suggest that the narrow focus on medico-legal and patient safety perspectives is complemented with moral philosophical perspectives to promote non-judgemental recognition and acknowledgement of guilt and of the fallible nature of medicine.
当分娩过程中失去或严重损害生命时，涉及的助产士和产科医生可能会在事后感到内疚。本文通过三个实证案例，考察了在当前医疗保健中的患者安全文化背景下，在不良事件发生后提倡无责追究的情况下，内疚感。目的是说明医疗保健专业人员在不良事件后即使没有过错也可能感到内疚，而 Gamland 的无罪责宽恕理论被用作该分析的理论框架。哲学洞察力已被证明是处理内疚等心理问题的有用资源，而 Gamland 关于错误和宽恕的观点阐明了医疗保健领域中创伤事件和医疗伤害领域的一个有趣困境，即医疗保健专业人员认为善意的行为可能会对患者造成伤害、伤害甚至死亡。未能认识到内疚感或内疚感可能会阻碍自我宽恕，这可能会对不良事件后助产士和产科医生的恢复产生负面影响。为医疗保健专业人员开发和改善支持系统是一项多方面的任务，作者建议将狭隘的重点放在医学法律和患者安全角度上，补充道德哲学观点，以促进对内疚感和医学易错性的无判断认识和承认。
