Department of Primary and Long-term care, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands.
TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE, The Netherlands.
Philos Ethics Humanit Med. 2023 Sep 6;18(1):12. doi: 10.1186/s13010-023-00140-w.
During the COVID-19 outbreak in 2020, national governments took restrictive measures, such as a visitors ban, prohibition of group activities and quarantine, to protect nursing home residents against infections. As 'safety' prevailed, residents and close relatives had no choice but to accept the restrictions. Their perspectives are relevant because the policies had a major impact on them, but they were excluded from the policy decisions. In this study we looked into the moral attitudes of residents, close relatives and volunteers regarding the restrictions in retrospect, and what moral lessons they considered important.
We conducted 30 semi-structured interviews with residents and close relatives and one focus group meeting with volunteers working in nursing homes. Data were transcribed verbatim and analyzed inductively. Subsequently, three Socratic dialogue meetings with residents, close relatives and volunteers were organized in which first analysis outcomes were discussed and dialogues were fostered into moral lessons for future pandemics. Outcomes were combined with moral theory following an empirical bioethics design.
Critical perspectives regarding the COVID-19 restrictions grew in time. Various moral values were compromised and steered moral lessons for our future. The participants recognized three moral lessons as most important. First, constructing tailored (well-balanced) solutions in practice is desirable. Second, proper recognition is needed for the caring role that close relatives fulfill in practice. Third, a responsive power distribution should be in place that includes all stakeholder perspectives who are affected by the restrictions.
Comparing the results with moral theory strengthens the plea for inclusion of all stakeholder groups in decision-making processes. To further concretize the moral lessons, tailored solutions can be realized with the use of moral case deliberations. Proper recognition includes actions addressing moral repair and including counter-stories in the debate. Responsive power distribution starts with providing clear and trustworthy information and including all perspectives.
在 2020 年 COVID-19 疫情期间，各国政府采取了限制措施，如禁止访客、禁止团体活动和隔离，以保护养老院居民免受感染。由于“安全”至上，居民和近亲别无选择，只能接受这些限制。他们的观点很重要，因为这些政策对他们产生了重大影响，但他们被排除在政策决策之外。在这项研究中，我们回顾了居民、近亲以及志愿者对这些限制的道德态度，以及他们认为重要的道德教训。
我们对居住在养老院的居民和近亲进行了 30 次半结构化访谈，并与在养老院工作的志愿者进行了一次焦点小组会议。数据逐字转录，并进行了归纳分析。随后，我们组织了三次与居民、近亲以及志愿者的苏格拉底对话会议，在会议上讨论了最初的分析结果，并促进了有关未来大流行病的对话和道德教训。根据经验生物伦理学的设计，将结果与道德理论相结合。
随着时间的推移，对 COVID-19 限制的批评观点不断增加。各种道德价值观受到了损害，并为我们的未来指明了道德教训。参与者认为以下三个道德教训最为重要。首先，在实践中构建量身定制（平衡）的解决方案是可取的。其次，需要适当承认近亲在实践中所扮演的关怀角色。第三，应该建立一个响应式的权力分配机制，包括所有受限制措施影响的利益相关者的观点。
将研究结果与道德理论进行比较，加强了呼吁让所有利益相关群体参与决策过程的观点。为了进一步具体落实道德教训，可以通过使用道德案例讨论来实现量身定制的解决方案。适当的承认包括采取行动纠正道德问题，并在辩论中纳入反例。响应式的权力分配从提供清晰和值得信赖的信息以及纳入所有观点开始。
