School of Medicine and Ethics Center, Emory University, Atlanta, GA, 30322, USA.
Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
BMC Public Health. 2022 Mar 16;22(1):510. doi: 10.1186/s12889-022-12950-2.
As 'disease detectives' and directors of public health programs, field epidemiologists play essential roles in protecting public health. Although ethical issues receive considerable attention in medical and research settings, less is known about ethical challenges faced by field epidemiologists in public health programs. Similarly, little is known about moral distress among field epidemiologists, i.e., situations in which they are constrained from acting on what they know to be morally right. Moral distress is strongly associated with empathy fatigue, burnout, reduced job retention, and disengagement. To better understand ethics training needs for field epidemiologists, in February 2019, members of TEPHIConnect, an online and mobile networking platform for Field Epidemiology Training Program (FETP) alumni, were invited to participate in an anonymous survey about ethical challenges and moral distress.
Among 126 respondents from 54 countries, leading causes of ethical dilemmas included inadequate informed consent (61%), inequitable allocation of resources (49%), and conflicts of interest (43%). These occur primarily in settings of disease outbreaks (60%); research (55%); and public health programs at the state, province, or national level (45%) or community level (43%). Work-related moral distress was reported by 91% of respondents, including 26% who experience it "frequently" or "almost always." Field epidemiologists working in low- and low-middle income countries were more likely to report moral distress "frequently" or "almost always" than those in higher-income countries (33.0% vs 9.1%, P = 0.006). The most common perceived contributors to moral distress included excessive stress and work demands (30%) and inadequate support from leaders (25%).
Field epidemiologists face significant work-related ethical challenges, which are endemic to public health and political systems. A substantial proportion of field epidemiologists also experience some degree of moral distress, often in association with these challenges. These findings indicate an unmet need among field epidemiologists for support in navigating ethical challenges, as well as for resources to address the human and professional consequences of moral distress.
作为“疾病侦探”和公共卫生项目的负责人，现场流行病学家在保护公众健康方面发挥着至关重要的作用。尽管医学和研究领域非常关注伦理问题，但对于现场流行病学家在公共卫生项目中面临的伦理挑战知之甚少。同样，对于现场流行病学家的道德困境（即他们受到限制，无法采取他们认为在道德上正确的行动）也知之甚少。道德困境与同理心疲劳、倦怠、降低工作保留率和脱离工作高度相关。为了更好地了解现场流行病学家的伦理培训需求，2019 年 2 月，TEPHIConnect 的成员（一个面向现场流行病学培训计划（FETP）校友的在线和移动网络平台）受邀参与了一项关于伦理挑战和道德困境的匿名调查。
在来自 54 个国家的 126 名受访者中，导致伦理困境的主要原因包括缺乏知情同意（61%）、资源分配不均（49%）和利益冲突（43%）。这些问题主要出现在疾病暴发（60%）、研究（55%）以及州、省或国家层面（45%）或社区层面（43%）的公共卫生项目中。91%的受访者报告工作相关的道德困境，其中 26%的人“经常”或“几乎总是”感到道德困境。在中低收入国家工作的现场流行病学家比在高收入国家工作的人更有可能“经常”或“几乎总是”报告道德困境（33.0%比 9.1%，P=0.006）。导致道德困境的最常见因素包括过度的压力和工作需求（30%）以及缺乏领导支持（25%）。
现场流行病学家面临着重大的工作相关伦理挑战，这些挑战是公共卫生和政治体系所固有的。相当一部分现场流行病学家也经历了一定程度的道德困境，这种情况往往与这些挑战有关。这些发现表明，现场流行病学家在应对伦理挑战方面需要得到支持，也需要资源来解决道德困境对人和职业的影响，这方面存在未满足的需求。
