Bosack Elena, Bourne Dawn, Epstein Elizabeth, Marshall Mary Faith, Chen Donna T
Medical student at the University of Miami Miller School of Medicine.
Assistant professor at the University of Virginia School of Nursing and a clinical ethics consultant at the Center for Health Humanities and Ethics at the University of Virginia School of Medicine.
Ethics Hum Res. 2025 Jan-Feb;47(1):34-45. doi: 10.1002/eahr.60006.
Moral distress occurs when professionals are constrained from taking what they believe to be ethically appropriate actions or are forced to take actions they believe are ethically inappropriate, challenging their professional identities and representing systems-level issues within organizations. Moral distress has been recognized in a variety of health care-related fields; however, the phenomenon is still comparatively unexplored among clinical research professionals (CRPs). In this qualitative study, we interviewed ten CRPs to unearth root causes of moral distress in this ethically unique profession. Four themes emerged from the data as contributors to moral distress: commodification of research; concern for research participants; compromised science; and structures of hierarchy. The experience of racism as a source of moral distress is also explored. The findings of this study indicate that the existence of moral distress in clinical research is troubling not only for the welfare of CRPs but also for the greater clinical research enterprise.
当专业人员在采取他们认为符合伦理道德的行动时受到限制，或者被迫采取他们认为不符合伦理道德的行动时，就会出现道德困扰，这对他们的职业身份构成挑战，并代表了组织内部的系统层面问题。道德困扰在各种与医疗保健相关的领域中都已得到认可；然而，在临床研究专业人员（CRP）中，这一现象仍相对未被深入研究。在这项定性研究中，我们采访了十位CRP，以挖掘这一具有独特伦理性质的职业中道德困扰的根本原因。数据中出现了四个导致道德困扰的主题：研究的商品化；对研究参与者的关注；受损的科学；以及等级制度结构。我们还探讨了种族主义作为道德困扰来源的经历。这项研究的结果表明，临床研究中道德困扰的存在不仅困扰着CRP的福祉，也困扰着更广泛的临床研究事业。
