Abbasi Mahmoud, Fadavi Mohsen, Bazmi Shabnam
Associate Professor, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
PhD Candidate in Medical Ethics, Department of Medical Ethics, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Med Ethics Hist Med. 2017 Dec 19;10:14. eCollection 2017.
Disasters are sudden catastrophic events leading to decisions in health service provision that are not in compliance with the principles and frameworks used in normal circumstances. It is essential to develop guidelines in order to ensure the ethical performance of health service providers and to prevent and manage the adverse consequences. As the first step in guideline development, the present study investigated the underlying factors affecting the ethical performance of health service providers in disasters. This was a qualitative research based on grounded theory, and was conducted through unstructured in-depth interviews with various health service providers including paramedics, physicians and crisis zone managers who had some experiences in a number of domestic and foreign disasters. The collected data were analyzed using conventional content analysis. The underlying factors extracted from the 24 interviews were divided into structural and mediatory factors. The structural factors covered the nature of the disaster, the type of social interactions, and lack of a unity management; the mediatory factors were connected to the emotional atmosphere governing the field, the behavior of the local people, the locals' economic status, the locals' trust in the authorities, and the safety of the crisis zone. We can look into more effective, continuous and dynamic relationships between the components of the process of ethical performance. It is evident, however, that the underlying factors have more effective roles than the other components. According to our findings, the role of the underlying, structural and mediatory factors are more of a threat than an opportunity in disasters.
灾难是突发的灾难性事件，会导致卫生服务提供方面的决策不符合正常情况下所使用的原则和框架。制定指南对于确保卫生服务提供者的道德行为以及预防和管理不良后果至关重要。作为指南制定的第一步，本研究调查了影响灾难中卫生服务提供者道德行为的潜在因素。这是一项基于扎根理论的定性研究，通过对包括护理人员、医生和危机地区管理人员在内的各类卫生服务提供者进行非结构化深度访谈来开展，这些人员在国内外一些灾难中都有相关经历。使用常规内容分析法对收集到的数据进行分析。从24次访谈中提取的潜在因素分为结构因素和中介因素。结构因素包括灾难的性质、社会互动的类型以及缺乏统一管理；中介因素与主导该领域的情感氛围、当地人的行为、当地人的经济状况、当地人对当局的信任以及危机地区的安全有关。我们可以探究道德行为过程各组成部分之间更有效、持续和动态的关系。然而，显然潜在因素比其他组成部分发挥着更有效的作用。根据我们的研究结果，在灾难中，潜在、结构和中介因素的作用更多的是构成威胁而非机遇。
