Department of Nursing, 42259Ulster University - Jordanstown Campus, Newtownabbey, UK.
Department of Nursing, 2596Ulster University - Coleraine Campus, Coleraine, UK.
Nurs Ethics. 2022 Sep;29(6):1401-1414. doi: 10.1177/09697330221075764. Epub 2022 May 27.
Escalating levels of obesity place enormous and growing demands on Health care provision in the (U.K.) United Kingdom. Resources are limited with increasing and competing demands upon them. Ethical considerations underpin clinical decision making generally, but there is limited evidence regarding the relationship between these variables particularly in terms of treating individuals with obesity.
To investigate the views of National Health Service (NHS) clinicians on navigating the ethical challenges and decision making associated with obesity management in adults with chronic illness.
A cross-sectional, multi-site survey distributed electronically.
A consensus sample of nurses, doctors, dietitians and final year students in two NHS Trusts and two Universities.
Ethical and governance approvals obtained from a National Ethics Committee (11NIR035), two universities and two teaching hospitals.
Of the total ( = 395) participants, the majority were nurses (48%), female (79%) and qualified clinicians (59%). Participants strongly considered the individual to have primary responsibility for a healthy weight and an obligation to attempt to maintain that healthy weight if they wish to access NHS care. Yet two thirds would not withhold treatment for patients with obesity.
While clinicians were clear about patient responsibility and obligations, the majority prioritised their duty of care and would not invoke a utilitarian approach to decision making. This may reflect awareness of obesity as a multi-faceted entity, with responsibility for support and management shared amongst society in general.
The attitudes of this sample of clinicians complemented the concept of the health service as being built on a principle of community, with each treated according to their need. However limited resources challenge the concept of needs-based decisions consequently societal engagement is necessary to agree a pragmatic way forward.
肥胖水平的不断上升给英国的医疗保健服务带来了巨大且日益增长的需求。资源有限，而对其的需求却在不断增加且竞争激烈。伦理考虑通常是临床决策的基础，但关于这些变量之间的关系，特别是在治疗肥胖个体方面，证据有限。
调查英国国民健康服务（NHS）临床医生在处理与慢性疾病成人肥胖管理相关的伦理挑战和决策时的观点。
一项横断面、多地点的电子调查。
来自两个 NHS 信托基金和两所大学的护士、医生、营养师和最后一年学生的共识样本。
从一个国家伦理委员会（11NIR035）、两所大学和两所教学医院获得了伦理和治理批准。
在总共（=395）名参与者中，大多数是护士（48%）、女性（79%）和合格的临床医生（59%）。参与者强烈认为个人对健康体重负有主要责任，如果他们希望获得 NHS 护理，有义务尝试维持健康体重。然而，三分之二的人不会拒绝为肥胖患者提供治疗。
虽然临床医生清楚患者的责任和义务，但大多数人优先考虑他们的护理责任，不会对决策采取功利主义的方法。这可能反映了他们对肥胖作为一个多方面实体的认识，支持和管理的责任由整个社会共同承担。
该临床医生样本的态度补充了健康服务基于社区原则的概念，每个患者都根据他们的需求得到治疗。然而，有限的资源挑战了基于需求的决策的概念，因此需要社会参与来达成一个实际可行的前进道路。
