运用共生经验伦理探索关系对临床伦理的意义：重置伦理研究项目的研究结果。
Using symbiotic empirical ethics to explore the significance of relationships to clinical ethics: findings from the Reset Ethics research project.
机构信息
Centre for Social Ethics and Policy, Department of Law, The University of Manchester, Manchester, UK.
School of Social and Political Sciences, University of Edinburgh, Edinburgh, UK.
出版信息
BMC Med Ethics. 2024 May 28;25(1):66. doi: 10.1186/s12910-024-01053-9.
BACKGROUND
At the beginning of the coronavirus (Covid-19) pandemic, many non-Covid healthcare services were suspended. In April 2020, the Department of Health in England mandated that non-Covid services should resume, alongside the continuing pandemic response. This 'resetting' of healthcare services created a unique context in which it became critical to consider how ethical considerations did (and should) underpin decisions about integrating infection control measures into routine healthcare practices. We draw on data collected as part of the 'NHS Reset Ethics' project, which explored the everyday ethical challenges of resetting England's NHS maternity and paediatrics services during the pandemic.
METHODS
Healthcare professionals and members of the public participated in interviews and focus group discussions. The qualitative methods are reported in detail elsewhere. The focus of this article is our use of Frith's symbiotic empirical ethics methodology to work from our empirical findings towards the normative suggestion that clinical ethics should explicitly attend to the importance of relationships in clinical practice. This methodology uses a five-step approach to refine and develop ethical theory based on a naturalist account of ethics that sees practice and theory as symbiotically related.
RESULTS
The Reset project data showed that changed working practices caused ethical challenges for healthcare professionals, and that infection prevention and control measures represented harmful barriers to the experience of receiving and offering care. For healthcare professionals, offering care as part of a relational interaction was an ethically important dimension of healthcare delivery.
CONCLUSIONS
Our findings suggest that foregrounding the importance of relationships across a hospital community will better promote the ethically important multi-directional expression of caring between healthcare professionals, patients, and their families. We offer two suggestions for making progress towards such a relational approach. First, that there is a change of emphasis in clinical ethics practice to explicitly acknowledge the importance of the relationships (including with their healthcare team) within which the patient is held. Second, that organisational decision-making should take into account the moral significance afforded to caring relationships by healthcare professionals, and the role such relationships can play in the negotiation of ethical challenges.
背景
在冠状病毒（Covid-19）大流行开始时，许多非 Covid 医疗服务被暂停。2020 年 4 月，英国卫生部规定，在继续应对大流行的同时，应恢复非 Covid 服务。这种医疗服务的“重置”创造了一个独特的背景，在这种背景下，考虑道德考虑因素如何（以及应该）为将感染控制措施纳入常规医疗实践的决策提供依据变得至关重要。我们借鉴了作为“NHS 重置伦理”项目一部分收集的数据，该项目探讨了大流行期间英格兰 NHS 妇产科和儿科服务重置的日常伦理挑战。
方法
医疗保健专业人员和公众参与了访谈和焦点小组讨论。详细的定性方法在其他地方报告。本文的重点是我们使用 Frith 的共生经验伦理方法，从我们的经验发现出发，走向规范建议，即临床伦理应该明确关注临床实践中关系的重要性。这种方法使用五步方法来改进和发展伦理理论，该理论基于一种将实践和理论视为共生关系的自然主义伦理观。
结果
重置项目数据显示，工作方式的改变给医疗保健专业人员带来了伦理挑战，而感染预防和控制措施代表了接受和提供护理体验的有害障碍。对于医疗保健专业人员来说，作为关系互动的一部分提供护理是医疗保健提供的一个重要的伦理维度。
结论
我们的研究结果表明，在医院社区中突出关系的重要性将更好地促进医疗保健专业人员、患者及其家属之间富有伦理意义的多向关怀表达。我们为朝着这种关系方法取得进展提出了两点建议。首先，临床伦理实践的重点应该转变，明确承认患者所处关系（包括与他们的医疗团队的关系）的重要性。其次，组织决策应该考虑到医疗保健专业人员赋予关怀关系的道德意义，以及这些关系在协商伦理挑战方面可以发挥的作用。
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