西班牙、墨西哥和阿根廷的内科医生遇到了哪些伦理冲突？一项基于自我管理调查的国际横断面观察性研究。
What ethical conflicts do internists in Spain, México and Argentina encounter? An international cross-sectional observational study based on a self-administrated survey.
机构信息
Emergency Department, 12 de Octubre University Hospital, Avenida de Córdoba, Madrid, Spain.
Bioethics and Professionalism Working Group, Spanish Society of Internal Medicine, Madrid, Spain.
出版信息
BMC Med Ethics. 2024 Nov 2;25(1):123. doi: 10.1186/s12910-024-01123-y.
BACKGROUND
The differences in clinical bioethics between the Mediterranean and Latin American cultures have not been analyzed. The objective of the study is to compare the ethical conflicts that internists in Spain, Mexico and Argentina have.
METHODS
Cross-sectional observational study through a survey directed at internists from Spain, Argentina and Mexico. The survey was administered to affiliated members of the National Societies of Internal Medicine across three countries via an online platform.
RESULTS
762 internists participated, 261 from Spain, 154 from Argentina and 347 from Mexico. The main ethical conflicts that internists in Spain, Argentina and Mexico have are related (in order) to the end of life, to the clinical relationship and to the patient's autonomy. Withholding and withdrawing life-sustaining treatment is the most frequent conflict in Spain and Argentina and the second in Mexico.
CONCLUSIONS
Internists from Spain and Argentina identify very similar ethical conflicts. Furthermore, they consider them more frequent and difficult than in Mexico. In Argentina they are less satisfied with the way they are resolved. To explain these differences, socio-cultural factors are postulated, among others: paternalism, individualism, masculinity, organization of the health system, formal training in bioethics and assessment of death.
背景
地中海和拉丁美洲文化之间的临床生物伦理学差异尚未得到分析。本研究的目的是比较西班牙、墨西哥和阿根廷内科医生的伦理冲突。
方法
通过对来自西班牙、阿根廷和墨西哥的内科医生进行调查的横断面观察研究。该调查通过在线平台向三个国家的国家内科医师学会的附属成员进行。
结果
共有 762 名内科医生参与了这项研究，其中 261 名来自西班牙，154 名来自阿根廷，347 名来自墨西哥。西班牙、阿根廷和墨西哥内科医生面临的主要伦理冲突（按顺序排列）与生命末期、临床关系和患者自主权有关。在西班牙和阿根廷， withholding 和 withdrawing life-sustaining treatment 是最常见的冲突，在墨西哥则是第二常见的冲突。
结论
来自西班牙和阿根廷的内科医生认为非常相似的伦理冲突。此外，他们认为这些冲突比在墨西哥更频繁和困难。在阿根廷，他们对解决这些冲突的方式不太满意。为了解释这些差异，人们假设了社会文化因素，包括：家长主义、个人主义、男性气质、卫生系统的组织、生物伦理学的正式培训和死亡评估。
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