Moses Lisa, Malowney Monica J, Wesley Boyd Jon
MSPCA-Angell Animal Medical Center, Boston, Massachusetts.
Center for Bioethics, Harvard Medical School, Boston, Massachusetts.
J Vet Intern Med. 2018 Nov;32(6):2115-2122. doi: 10.1111/jvim.15315. Epub 2018 Oct 15.
Concerns about ethical conflicts, moral distress, and burnout in veterinary practice are steadily increasing. Root causes of these problems have not been rigorously identified. Little research has been done to evaluate the existence of moral distress in North American veterinarians or to explore its impact on career sustainability and poor well-being.
HYPOTHESIS/OBJECTIVES: Ethical conflict and resultant moral distress are common occurrences in contemporary veterinary practice and negatively impact daily practice life, but may not be identified or labeled by veterinarians as such.
No animals were used in this study.
Mixed methods sequential explanatory design; confidential and anonymous on-line sampling of 889 veterinarians in North America.
A majority of respondents reported feeling conflict over what care is appropriate to provide. Over 70% of respondents felt that the obstacles they faced that prevented them from providing appropriate care caused them or their staff moderate to severe distress. Seventy-nine percent of participants report being asked to provide care that they consider futile. More than 70% of participants reported no training in conflict resolution or self-care.
Veterinarians report widespread ethical conflict and moral distress across many practice types and demographics. Most veterinarians have little to no training on how to decrease the impact of these problems. Ethical conflict and resulting moral distress may be an important source of stress and poor well-being that is not widely recognized or well defined. Well-researched and effective tools used to decrease moral distress in human healthcare could be adapted to ameliorate this problem.
对兽医行业中伦理冲突、道德困扰和职业倦怠的担忧正与日俱增。这些问题的根本原因尚未得到严格界定。在北美兽医中，几乎没有开展研究来评估道德困扰的存在情况，也没有探索其对职业可持续性和健康状况不佳的影响。
假设/目标：伦理冲突及由此产生的道德困扰在当代兽医实践中很常见，会对日常实践生活产生负面影响，但兽医可能并未将其识别或认定为这类问题。
本研究未使用动物。
采用混合方法序贯解释性设计；对北美889名兽医进行保密且匿名的在线抽样调查。
大多数受访者表示在提供何种适当护理方面存在冲突。超过70%的受访者认为，他们面临的阻碍其提供适当护理的因素给他们自己或员工带来了中度至重度困扰。79%的参与者报告曾被要求提供他们认为无意义的护理。超过70%的参与者表示未接受过冲突解决或自我护理方面的培训。
兽医报告称，在许多实践类型和不同人群中都广泛存在伦理冲突和道德困扰。大多数兽医几乎没有接受过关于如何降低这些问题影响的培训。伦理冲突及由此产生的道德困扰可能是压力和健康状况不佳的一个重要来源，而这一点尚未得到广泛认识或明确界定。用于减少人类医疗保健中道德困扰的经过充分研究且有效的工具可加以改编以改善这一问题。
