Piasecki Jan, Dranseika Vilius
Department of Philosophy and Bioethics, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
Department of Philosophy and Bioethics, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
J Med Ethics. 2020 Mar 27. doi: 10.1136/medethics-2019-105658.
Clinicians and administrators have a professional obligation to contribute (OTC) to improvement of healthcare quality. At the same time, participation in embedded research poses risks to healthcare institutions. Disclosure of an institution's sensitive information could endanger relationships with patients and undermine its reputation. The existing ethical framework (EF) for learning healthcare systems (LHSs) does not address the conflict between the OTC and institutional interests. Ethical guidance and policy regulation are needed to create a safe environment for embedded research. In this article we analyse the EF for LHSs and the concept of professionalism. We suggest that the EF should be supplemented with an obligation to protect provider's legitimate interests. We define legitimate interests as those that enable providers to discharge their primary duties. We argue that both the OTC and the obligation to protect legitimate interests are grounded in the concept of medical professionalism and can be understood as a matter of contract between a democratic society and medical professionals. The proposed supplemented EF can be implemented into a regulatory system in three different ways: the : where providers decide themselves how to balance the ethical claims, the centralised: where a governmental institution decides the right balance between providers' interests and interests of a health system; and the : where medical professionals, the state and patients negotiate their interests. Our article contributes to the discussion on ethical relevance of providers' interests and the regulatory model for weighing opposite interests in LHSs.
临床医生和管理人员有促进医疗质量提升的职业义务。与此同时，参与嵌入式研究给医疗机构带来风险。机构敏感信息的披露可能危及与患者的关系并损害其声誉。现有的学习型医疗系统（LHS）伦理框架（EF）并未解决促进医疗质量提升与机构利益之间的冲突。需要伦理指导和政策监管来为嵌入式研究创造一个安全的环境。在本文中，我们分析了学习型医疗系统的伦理框架和专业精神的概念。我们建议伦理框架应补充保护提供者合法利益的义务。我们将合法利益定义为使提供者能够履行其主要职责的利益。我们认为，促进医疗质量提升和保护合法利益的义务都基于医学专业精神的概念，并且可以被理解为民主社会与医学专业人员之间的一种契约问题。提议的补充伦理框架可以通过三种不同方式纳入监管体系：自主型，即由提供者自行决定如何平衡伦理诉求；集中型，即由政府机构决定提供者利益与卫生系统利益之间的正确平衡；协商型，即医学专业人员、国家和患者就各自利益进行协商。我们的文章有助于讨论提供者利益的伦理相关性以及学习型医疗系统中权衡相反利益的监管模式。
