Department of Bioethics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 8608556, Japan.
Department of Medical Ethics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
BMC Med Ethics. 2023 Oct 4;24(1):79. doi: 10.1186/s12910-023-00960-7.
Healthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of justice and care are applied to the cause of actual moral conflict. We aim to clarify the structure and factors of healthcare professionals' moral conflicts through the lens of justice and care to obtain suggestions for conflict resolutions.
Semi-structured interviews about experiences of moral conflict were conducted with Japanese nurses recruited using the snowball sampling method. Interviews were conducted based on the real-life moral conflict and choice interview. Interviews were recorded and transcribed verbatim, then analyzed based on the interpretive method of data analysis. Verbatim transcripts were read four times, first to get an overall sense of the conflict, then to understand the person's thoughts and actions that explain the conflict, and third and fourth to identify perspectives of justice and care, respectively. Each moral perspective was classified into categories according to Chally's taxonomy.
Among 31 responses, 2 that did not mention moral conflict were excluded, leaving 29 responses that were analyzed. These responses were classified into six cases with conflict between both justice and care perspectives or within one perspective, and into two cases without conflict between perspectives. The "rules" category of justice and the "welfare of others" category of care were included in many cases of conflict between two perspectives, and they frequently occurred in each perspective.
The nurses in this study suggest that they make moral judgments based on moral values that are intertwined with justice and care perspectives complex manner.Organizational, professional, and patient-related factors influenced conflicts between justice and care. Additionally, multiple overlapping loyalties created conflicts within justice perspectives, and multifaceted aspects of care-provider's responsibility and patient need created conflicts within care. Decision-making biased towards one perspective can be distorted. It is important to consider ethical issues from both perspectives to resolve conflicts, especially the effective use of the ethics of care is recommended.
医疗保健专业人员使用公正和关爱伦理来构建道德推理。这些伦理在本质上存在冲突；不同的价值体系和公正与关爱秩序适用于实际道德冲突的原因。我们旨在通过公正和关爱的视角澄清医疗保健专业人员道德冲突的结构和因素，以获得冲突解决的建议。
使用雪球抽样法招募日本护士，进行关于道德冲突经历的半结构化访谈。访谈基于真实的道德冲突和选择访谈进行。采访进行了录音并逐字记录，然后根据数据分析的解释方法进行分析。逐字记录被阅读了四次，第一次是为了总体了解冲突，然后是为了理解解释冲突的人的思想和行动，第三次和第四次分别是为了识别公正和关爱的视角。每个道德视角都根据 Chally 的分类法分为类别。
在 31 个回复中，排除了 2 个没有提到道德冲突的回复，留下 29 个回复进行分析。这些回复分为六个案例，包括两个视角之间的冲突或一个视角内的冲突，以及两个没有视角冲突的案例。正义的“规则”类别和关爱中的“他人福利”类别包含在许多两个视角之间冲突的案例中，并且经常出现在每个视角中。
本研究中的护士表明，他们以正义和关爱视角相互交织的道德价值观为基础，以复杂的方式做出道德判断。组织、专业和患者相关因素影响了正义与关爱之间的冲突。此外，多个重叠的忠诚在正义视角内造成了冲突，而关怀提供者的责任和患者需求的多方面方面在关怀视角内造成了冲突。偏向于一个视角的决策可能会扭曲。从两个视角考虑伦理问题以解决冲突很重要，特别是建议有效利用关爱伦理。
