Alexander Denise, Quirke Mary, Greene Jo, Cassidy Lorna, Hilliard Carol, Brenner Maria
School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
Maynooth University, Maynooth, Ireland.
BMC Med Ethics. 2024 Feb 19;25(1):20. doi: 10.1186/s12910-024-01017-z.
There is considerable variation in the functionality of bioethical services in different institutions and countries for children in hospital, despite new challenges due to increasing technology supports for children with serious illness and medical complexity. We aimed to understand how bioethics services address bioethical concerns that are increasingly encountered in paediatric intensive care.
A qualitative descriptive design was used to describe clinician's perspectives on the functionality of clinical bioethics services for paediatric intensive care units. Clinicians who were members of formal or informal clinical bioethics groups, or who were closely involved with the process of working through ethically challenging decisions, were interviewed. Interviews took place online. Resulting transcripts were analysed using thematic analysis.
From 33 interviews, we identified four themes that described the functionality of bioethics services when a child requires technology to sustain life: striving for consensus; the importance of guidelines; a structure that facilitates a time-sensitive and relevant response; and strong leadership and teamwork.
Clinical bioethics services have the potential to expand their role due to the challenges brought by advancing medical technology and the increasing options it brings for treatment. Further work is needed to identify where and how bioethics services can evolve and adapt to fully address the needs of the decision-makers in PICU.
尽管针对患有严重疾病和医疗复杂性的儿童的技术支持不断增加带来了新的挑战，但不同机构和国家为住院儿童提供的生物伦理服务功能存在很大差异。我们旨在了解生物伦理服务如何应对儿科重症监护中日益常见的生物伦理问题。
采用定性描述性设计来描述临床医生对儿科重症监护病房临床生物伦理服务功能的看法。对正式或非正式临床生物伦理小组的成员，或密切参与处理具有伦理挑战性决策过程的临床医生进行了访谈。访谈通过网络进行。使用主题分析法对所得的访谈记录进行分析。
通过33次访谈，我们确定了四个主题，描述了在儿童需要技术维持生命时生物伦理服务的功能：争取达成共识；指南的重要性；有助于及时做出相关回应的架构；以及强有力的领导和团队合作。
由于先进医疗技术带来的挑战及其带来的更多治疗选择，临床生物伦理服务有扩大其作用的潜力。需要进一步开展工作，以确定生物伦理服务在何处以及如何发展和适应，从而充分满足儿科重症监护病房决策者的需求。
