Bruun H, Lystbaek S G, Stenager E, Huniche L, Pedersen R
Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Psychiatric hospitals, the Region of Southern Denmark, Toldbodgade 45, 5000, Odense, Denmark.
BMC Med Ethics. 2018 Jun 19;19(1):62. doi: 10.1186/s12910-018-0308-z.
The aim of this article is to give more insight into what ethical challenges clinicians in mental healthcare experience and discuss with a Clinical Ethics Committee in psychiatry in the Region of Southern Denmark. Ethical considerations are an important part of the daily decision-making processes and thereby for the quality of care in mental healthcare. However, such ethical challenges have been given little systematic attention - both in research and in practices.
A qualitative content analysis of 55 written case-reports from the Clinical Ethics Committee. The Committee offers clinicians in mental healthcare structured ethical analyses of ethical challenges and makes a thorough written case-report.
The ethical challenges are grouped into three overarching topics: 1. Clinicians and their relation to patients and relatives. 2. Clinicians and institutional aspects of mental healthcare 3. Clinicians and mental healthcare in a wider social context. Through presentation of illustrative examples the complexity of daily clinical life in mental healthcare becomes evident, as well as typical interests, values and arguments.
This qualitative study indicates that difficult ethical challenges are an inherent part of mental healthcare that requires time, space and competence to be dealt with adequately.
本文旨在更深入地了解精神卫生保健领域的临床医生所面临的伦理挑战，并与丹麦南部地区的精神病学临床伦理委员会进行讨论。伦理考量是日常决策过程的重要组成部分，因此对精神卫生保健的护理质量也很重要。然而，此类伦理挑战在研究和实践中都很少受到系统关注。
对临床伦理委员会的55份书面病例报告进行定性内容分析。该委员会为精神卫生保健领域的临床医生提供对伦理挑战的结构化伦理分析，并撰写详尽的书面病例报告。
伦理挑战分为三个总体主题：1. 临床医生及其与患者和亲属的关系。2. 临床医生与精神卫生保健的机构层面。3. 临床医生与更广泛社会背景下的精神卫生保健。通过展示实例，精神卫生保健日常临床生活的复杂性以及典型的利益、价值观和论据变得显而易见。
这项定性研究表明，棘手的伦理挑战是精神卫生保健的固有组成部分，需要时间、空间和能力才能得到充分应对。
