Civaner M Murat, Vatansever Kevser, Pala Kayihan
Department of Medical Ethics, Uludag University School of Medicine, Bursa, Turkey.
Department of Medical Education, Ege University School of Medicine, Izmir, Turkey.
PLoS One. 2017 Mar 20;12(3):e0174162. doi: 10.1371/journal.pone.0174162. eCollection 2017.
Natural disasters, armed conflict, migration, and epidemics today occur more frequently, causing more death, displacement of people and economic loss. Their burden on health systems and healthcare workers (HCWs) is getting heavier accordingly. The ethical problems that arise in disaster settings may be different than the ones in daily practice, and can cause preventable harm or the violation of basic human rights. Understanding the types and the determinants of ethical challenges is crucial in order to find the most benevolent action while respecting the dignity of those affected people. Considering the limited scope of studies on ethical challenges within disaster settings, we set upon conducting a qualitative study among local HCWs.
Our study was conducted in six cities of Turkey, a country where disasters are frequent, including armed conflict, terrorist attacks and a massive influx of refugees. In-depth interviews were carried out with a total of 31 HCWs working with various backgrounds and experience. Data analysis was done concurrently with ongoing interviews.
Several fundamental elements currently hinder ethics in relief work. Attitudes of public authorities, politicians and relief organizations, the mismanagement of impromptu humanitarian action and relief and the media's mindset create ethical problems on the macro-level such as discrimination, unjust resource allocation and violation of personal rights, and can also directly cause or facilitate the emergence of problems on the micro-level. An important component which prevents humanitarian action towards victims is insufficient competence. The duty to care during epidemics and armed conflicts becomes controversial. Many participants defend a paternalistic approach related to autonomy. Confidentiality and privacy are either neglected or cannot be secured.
Intervention in factors on the macro-level could have a significant effect in problem prevention. Improving guidelines and professional codes as well as educating HCWs are also areas for improvement. Also, ethical questions exposed within this study should be deliberated and actualized with universal consensus in order to guide HCWs and increase humane attitudes.
如今，自然灾害、武装冲突、移民和流行病愈发频繁地发生，造成了更多的死亡、人员流离失所和经济损失。相应地，它们给卫生系统和医护人员带来的负担也日益加重。灾害环境中出现的伦理问题可能与日常实践中的不同，并且可能导致可预防的伤害或基本人权的侵犯。了解伦理挑战的类型和决定因素对于在尊重受灾者尊严的同时找到最有益的行动至关重要。鉴于灾害环境中关于伦理挑战的研究范围有限，我们着手对当地医护人员进行一项定性研究。
我们的研究在土耳其的六个城市开展，该国灾害频发，包括武装冲突、恐怖袭击和大量难民涌入。共对31名具有不同背景和经验的医护人员进行了深入访谈。数据分析与访谈同步进行。
目前有几个基本因素阻碍了救援工作中的伦理规范。公共当局、政治家和救援组织的态度、即兴人道主义行动和救援的管理不善以及媒体的思维方式在宏观层面上造成了伦理问题，如歧视、不公正的资源分配和个人权利的侵犯，并且还可能直接导致或助长微观层面问题的出现。阻碍对受害者采取人道主义行动的一个重要因素是能力不足。在流行病和武装冲突期间的护理职责变得具有争议性。许多参与者支持一种与自主权相关的家长式做法。保密性和隐私要么被忽视，要么无法得到保障。
对宏观层面因素的干预可能对预防问题产生重大影响。改进指导方针和专业规范以及对医护人员进行教育也是需要改进的方面。此外，本研究中揭示的伦理问题应经过深思熟虑并达成普遍共识后加以落实，以指导医护人员并增强人文关怀态度。
