College of Health Sciences, School of Medicine, Department of Anatomy, Makerere University, Kampala, Uganda.
Joint Clinical Research Center, Lubowa, Kampala, Uganda.
BMC Med Ethics. 2024 Aug 9;25(1):87. doi: 10.1186/s12910-024-01085-1.
Globally, healthcare providers (HCPs), hospital administrators, patients and their caretakers are increasingly confronted with complex moral, social, cultural, ethical, and legal dilemmas during clinical care. In high-income countries (HICs), formal and informal clinical ethics support services (CESSs) have been used to resolve bioethical conflicts among HCPs, patients, and their families. There is limited evidence about mechanisms used to resolve these issues as well as experiences and perspectives of the stakeholders that utilize them in most African countries including Uganda.
This phenomenological qualitative study utilized in-depth interviews (IDIs) and focus group discussions (FGDs) to collect data from Uganda Cancer Institute (UCI) staff, patients, and caretakers who were purposively selected. Data was analyzed deductively and inductively yielding themes and sub-themes that were used to develop a codebook.
The study revealed there was no formal committee or mechanism dedicated to resolving ethical dilemmas at the UCI. Instead, ethical dilemmas were addressed in six forums: individual consultations, tumor board meetings, morbidity and mortality meetings (MMMs), core management meetings, rewards and sanctions committee meetings, and clinical departmental meetings. Participants expressed apprehension regarding the efficacy of these fora due to their non-ethics related agendas as well as members lacking training in medical ethics and the necessary experience to effectively resolve ethical dilemmas.
The fora employed at the UCI to address ethical dilemmas were implicit, involving decisions made through various structures without the guidance of personnel well-versed in medical or clinical ethics. There was a strong recommendation from participants to establish a multidisciplinary clinical ethics committee comprising members who are trained, skilled, and experienced in medical and clinical ethics.
在全球范围内，医疗保健提供者（HCPs）、医院管理人员、患者及其护理人员在临床护理中越来越多地面临复杂的道德、社会、文化、伦理和法律困境。在高收入国家（HICs），已经使用正式和非正式的临床伦理支持服务（CESSs）来解决 HCPs、患者及其家属之间的生物伦理冲突。在包括乌干达在内的大多数非洲国家，关于解决这些问题的机制以及利用这些机制的利益相关者的经验和观点的证据有限。
这项现象学定性研究利用深入访谈（IDIs）和焦点小组讨论（FGDs）从乌干达癌症研究所（UCI）的工作人员、患者和护理人员中收集数据，这些人员是经过精心挑选的。数据采用演绎和归纳分析，得出主题和子主题，用于开发代码本。
该研究表明，UCI 没有专门解决伦理困境的正式委员会或机制。相反，伦理困境在六个论坛上得到解决：个别咨询、肿瘤委员会会议、发病率和死亡率会议（MMMs）、核心管理会议、奖励和制裁委员会会议以及临床部门会议。参与者对这些论坛的功效表示担忧，因为它们与伦理无关的议程以及成员缺乏医学伦理培训和必要的经验，无法有效地解决伦理困境。
UCI 用于解决伦理困境的论坛是隐含的，涉及通过各种结构做出决策，而没有熟悉医学或临床伦理的人员的指导。参与者强烈建议成立一个由接受过医学和临床伦理培训、有技能和经验的成员组成的多学科临床伦理委员会。
