Sato Hiroyuki, Takimoto Yoshiyuki
Department of Biomedical Ethics, Faculty of Medicine The University of Tokyo Tokyo Japan.
PCN Rep. 2023 Apr 12;2(2):e86. doi: 10.1002/pcn5.86. eCollection 2023 Jun.
Psychiatrists often encounter ethical dilemmas in their daily clinical practice. Clinical ethics consultations (CECs) have been recently increasing, especially in general hospitals. However, the current situation in the psychiatric field is unclear. This study clarifies clinical ethics problems in psychiatry and determines the need for CECs.
We conducted an anonymous self-administered questionnaire survey in February 2022, which targeted directors and supervisors of psychiatric specialty training programs at 1224 psychiatry facilities.
Responses were received from 311 facilities (response rate: 25.4%). CEC systems existed in 223 (72.2%) facilities, and medical safety committees were the most common. Clinical ethics problems occurred at 248 (80.3%) facilities; the most common method for managing the problems was discussions at case conferences without using CECs. The top four reasons for psychiatrists to solicit advice were conflicts with patients' relatives, treating a patient with cognitive impairment, discontinuation of treatment, and suicide/attempted suicide. Most respondents (89.9%) considered CECs necessary.
Although CECs exist in psychiatry, they may not meet the needs of clients. Future studies are needed to investigate client satisfaction and CEC evaluation methods in facilities where psychiatric CECs are provided.
精神科医生在日常临床实践中经常遇到伦理困境。临床伦理咨询（CEC）近来不断增加，尤其是在综合医院。然而，精神科领域的现状尚不明晰。本研究阐明精神科的临床伦理问题并确定对CEC的需求。
我们于2022年2月进行了一项匿名自填式问卷调查，对象为1224家精神科机构的精神科专科培训项目主任和督导。
共收到311家机构的回复（回复率：25.4%）。223家（72.2%）机构设有CEC系统，其中医疗安全委员会最为常见。248家（80.3%）机构出现过临床伦理问题；处理这些问题最常用的方法是在病例讨论会上进行讨论，而不使用CEC。精神科医生寻求建议的前四大原因是与患者亲属发生冲突、治疗认知障碍患者、停止治疗以及自杀/自杀未遂。大多数受访者（89.9%）认为有必要设立CEC。
虽然精神科设有CEC，但可能无法满足服务对象的需求。未来需要开展研究，调查提供精神科CEC的机构中服务对象的满意度及CEC评估方法。
