Rasoal Dara, Skovdahl Kirsti, Gifford Mervyn, Kihlgren Annica
School of Health and Medical Sciences, Örebro University, Fakultetsgatan 1, SE - 701 82, Örebro, Sweden.
Department of Nursing and Health Sciences, University College in Southeast Norway, Drammen, Norway.
HEC Forum. 2017 Dec;29(4):313-346. doi: 10.1007/s10730-017-9325-4.
This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different countries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a "bottom-up" perspective might give healthcare personnel opportunities to think and reflect more than a "top-down" perspective. A "bottom-up" approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a "top-down" approach risks removing such moral responsibility.
本研究描述了在临床实践中，有哪些临床伦理方法可从其构建、功能和目标方面为医护人员提供支持。医护人员在工作过程中经常面临伦理困境，这些问题涵盖从产前护理到临终关怀等广泛领域。尽管已经开发出各种形式的临床伦理支持，但据我们所知，缺乏综述研究来描述有哪些伦理支持方法、它们是如何构建的以及在临床实践中支持医护人员的目标。本研究进行了一项综合文献综述。我们使用CINAHL、MEDLINE和Psych INFO数据库中的特定医学主题词和手动关键词，搜索了2000年至2016年间用英文撰写的同行评审学术文章。全球共有54篇文章描述了临床伦理支持方法，包括临床伦理咨询、临床伦理委员会、道德案例审议、伦理查房、伦理讨论小组和伦理反思小组。临床伦理咨询和临床伦理委员会在不同国家有不同的角色和功能。它们可以就最佳行动方案向医护人员提供建议和推荐。道德案例审议、伦理查房、伦理讨论小组和伦理反思小组支持这样一种观点，即小组反思能增强对伦理问题的洞察力。“自下而上”视角的临床伦理支持可能比“自上而下”视角给医护人员更多思考和反思的机会。“自下而上”的方法让医护人员对其在临床实践中的行动选择承担道德责任，而“自上而下”的方法则有消除这种道德责任的风险。
