Dekeuwer Catherine, Bogaert Brenda, Eggert Nadja, Harpet Claire, Romero Morgane
Faculté de Philosophie, Institut de Recherches Philosophiques de Lyon, Université Jean Moulin, 18 rue Chevreul, 69007, Lyon, France.
Chaire Valeurs du Soin Centré Patient, Institut de Recherches Philosophiques de Lyon, Université Jean Moulin, 18 rue Chevreul, 69007, Lyon, France.
Med Health Care Philos. 2019 Dec;22(4):515-529. doi: 10.1007/s11019-019-09907-5.
The French medical context is characterized by institutionalization of the ethical reflection in health care facilities and an important disparity between spaces of ethical reflection. In theory, the healthcare professional may mobilise an arsenal of resources to help him in his ethical reflection. But what happens in practice? We conducted semi-structured interviews with 22 health-care professionals who did and did not have recourse to clinical ethical committees. We also implemented two focus groups with 18 professionals involved in various spaces of ethical reflection in order to let them debate about a better way to organize ethical reflection in their institutional contexts. The qualitative analysis allows to us to underline the coexistence of different conceptions of ethics among health care professionals. We also observed that the participants in our study shared the experience of ethically problematic situations as roadblocks in the process of communication and decision-making. We therefore report the factors which favour or inhibit the ethical course leading to the resolution or at the very least soothing of the situation at hand. Finally, we discuss methodological issues and underline the fact that while the patient is at the heart of the professional's ethical preoccupations, this does not imply that they are actors in decisions that concern them.
法国的医疗环境特点是医疗保健机构中伦理反思的制度化，以及伦理反思空间存在重大差异。理论上，医疗保健专业人员可以动用一系列资源来辅助其进行伦理反思。但实际情况如何呢？我们对22名曾求助和未曾求助于临床伦理委员会的医疗保健专业人员进行了半结构化访谈。我们还与18名参与不同伦理反思空间的专业人员开展了两个焦点小组讨论，以便让他们就如何在其机构环境中更好地组织伦理反思展开辩论。定性分析使我们能够强调医疗保健专业人员中不同伦理观念的共存。我们还观察到，我们研究中的参与者都经历过伦理问题情境，这些情境成为沟通和决策过程中的障碍。因此，我们报告了有利于或阻碍道德进程的因素，这些因素可导致解决或至少缓解当前的情况。最后，我们讨论了方法学问题，并强调了这样一个事实，即虽然患者是专业人员伦理关注的核心，但这并不意味着他们是涉及自身决策的参与者。
