Proctor E K, Morrow-Howell N, Lott C L
George Warren Brown School of Social Work, Washington University, St. Louis, MO 63130.
Soc Work. 1993 Mar;38(2):166-77.
The authors used categories based on the NASW Code of Ethics to code hospital social workers' descriptions of ethical dilemmas according to the specific principles in conflict. They also developed codes to identify discharge destination and medical care issues involved in the ethical dilemma. Most ethical dilemmas were found to involve conflicts between client self-determination and client best interest. Ethical dilemmas were more likely when patient mental status was impaired and when decision making was problematic. Ethical dilemmas were related to delayed discharge, in-hospital mortality, and less-than-adequate postdischarge care. The study enhances understanding of ethical dilemmas and advances a methodology for studying their occurrence and consequences.
作者根据美国社会工作者协会（NASW）的道德准则，依据冲突中的具体原则，对医院社会工作者对伦理困境的描述进行编码。他们还制定了编码，以识别伦理困境中涉及的出院目的地和医疗护理问题。研究发现，大多数伦理困境涉及客户自我决定权与客户最佳利益之间的冲突。当患者精神状态受损以及决策存在问题时，出现伦理困境的可能性更大。伦理困境与出院延迟、院内死亡率以及出院后护理不足有关。该研究增进了对伦理困境的理解，并推进了一种研究其发生及后果的方法。
