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Public health emergencies not only bring great challenges to the conventional public health system, but also face some ethical dilemmas in the governance process. For example, the compulsory isolation measures affect the normal lives of some citizens, the normal medical treatment of non-epidemic patients may be constrained by complex governance environments, and the relationship between patient privacy protection and the public’s right to know needs to be deeply considered and balanced. To respond the ethical dilemmas in public health emergencies, it is necessary to explore more effective new ideas and methods under ethical concepts, combine with ethical needs in the governance of public health emergencies, comprehensively improve governance capabilities starting from the basic principles and behavioral standards of governance, with a view to providing more effective ethical support for the governance of public health emergencies.
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【Objective:】 To explore the ethical dilemmas faced by the critical care physicians in the process of practicing the right to informed consent in a region of Beijing. 【Methods:】 14 doctors in the critical care unit from 5 medical institutions in a certain region of Beijing were interviewed in depth face-to-face by qualitative research method. The data obtained were analyzed through coding, classification, and extraction of subjects. 【Results:】 The lack of trust in doctor-patient communication leads to the instrumentalization of the right to know. When the decision of family members is inconsistent with the patient’s right to life and health, doctors are faced with the dilemma of choice and its impact. 【Conclusions:】 Faced with such ethical dilemmas, it is suggested to rebuild doctor-patient trust through multiple measures, and make appropriate restrictions on the agent-executing of the right of informed consent.
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The retention of emergency patients is a common problem faced by hospitals worldwide. In addition to medical problems, social, family, economic and other problems will also cause patients to stay in the emergency department. It not only brings challenges to patients’ own disease treatment and hospital operation and management, but also brings ethical dilemmas. Taking the service cases of medical social workers who involved in stranded patients in Shanghai E Hospital as an example, this paper analyzed 20 service records and interviews with social workers receiving cases, and combed the ethical dilemmas faced by medical social workers in the process of involving in emergency stranded patients. It was found that medical social workers faced many ethical dilemmas in the process of involving in emergency stranded patients, such as interpersonal relations and relevant legal regulations, the right to life and health and the right to informed consent, the self-determination of case owners and the allocation of medical resources. In this regard, it is suggested to solve the problem of patient retention by advocating the improvement of relevant systems and policies, building cooperative teams to smooth referral channels, strengthening education, and promoting family shared decision-making.
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The positive role of hospice social work in responding to the needs of terminal cancer patients and their families has been highlighted, and has also triggered discussions on localized ethical issues. Taking the casework of terminal cancer patients as an example, this paper analyzed the specific manifestations and causes of ethical dilemmas in the practice of hospice social work, and then provided ideas for coping with them. It was found that hospice care casework workers face four ethical dilemmas, including quality of life dilemmas, emotional boundaries dilemmas, power relationship dilemmas, and cultural respect dilemmas. Service managers can enhance the ethical issue response ability of front-line workers by improving the collaborative service mechanism between medical and social institutions, constructing a whole-process professional supervision system, conducting skills training for caring social workers, and expanding patient and family life education services. The ethical dilemmas in hospice social work service are localized, and will affect the service effect. The response to these issues requires the joint participation of the government, society, universities, hospitals, and front-line social workers.
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Ethical dilemmas commonly exist among nurses during the epidemic prevention and control of major infectious diseases, which can affect their physical and mental health and nursing quality. This paper reviewed the ethical dilemmas of nurses in the epidemic prevention and control of major infectious diseases from four aspects, including concepts, current situation, evaluation tools, and influencing factors, with a view to raising the attention of nurses, nursing administrators, and health management organizations to the ethical dilemmas of nurses in the epidemic prevention and control of major infectious diseases, and providing theoretical references for further formulating strategies. In terms of ethical dilemmas research of nurses during the prevention and control of major infectious diseases, domestic and foreign studies mostly used scales and qualitative interviews to investigate. Research has found that the ethical dilemmas of nurses during the period include the ethical dilemma of visiting restrictions, the ethical dilemma of fair allocation of scarce resources, and the ethical dilemma of nurses’ rights and obligations. The main influencing factors include demographic factors, psychological factors, risk perception, and social support. It is recommended to develop suitable assessment tools from the perspective of ethical in the future, timely grasp the current situation of ethical dilemmas of nurses during the prevention and control of major infectious diseases, and deeply explore influencing factors.
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El cuidado del equipo interprofesional de salud es un factor indispensable para que el sistema sanitario funcione de manera estable y resi-liente, especialmente cuando la presión se vuelve extrema. La pandemia, además de poner a prueba los sistemas de salud y sus actores, ha dejado algunas dudas respecto a los alcances del profesionalismo, frente a las demandas y expectativas que la sociedad tiene. Para efectos de la presente revisión, el concepto de profesionalismo en tiempos de crisis incluye controversias y dilemas que surgen en la relación con la sociedad, ética profesional y responsabilidad sobre el autocuidado. El compromiso y la resiliencia para garantizar el cuidado del paciente son evidentes en el actuar de los profesionales de la salud; sin embargo, en ocasiones esto ha ido en detrimento de su propia integridad física y moral. La agenda de salud en México está en deuda con médicos, residentes y profesionales de enfermería, una vía para saldarla es a través del fortalecimiento de las instituciones, la definición de políticas y normativas institucionales que promuevan el autocuidado y, entre otras medidas, el establecimiento de sistemas que no obliguen a aquéllos a convertirse en héroes enfrentados a los riesgos de una crisis.
The care of the interprofessional health team is an indispensable factor for the health system to function in a stable and resilient manner, especially when the pressure becomes extreme. In addition to putting health systems and their actors to the test, the pandemic has left some doubts about the scope of professionalism in the face of society's demands and expectations. For this review, the concept of professionalism in times of crisis includes controversies and dilemmas that arise in the relationship with the community, professional ethics, and responsibility for self-care. Commitment and resilience to ensure patient care are evident in the actions of health professio-nals; however, at times, this has been to the detriment of their own physical and moral integrity. The health system in Mexico is indebted to physicians, residents, and nursing professionals, and a way to settle it is through the strengthening of institutions, the definition of institutional policies and regulations that promote self-care, and, among other measures, the establishment of systems that do not force them to become heroes facing the risks of a crisis.
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PURPOSE: This study compares experiences of ethical dilemma between nurses working in intensive care units and those in general units under specific situations of treatment decisions and confidentiality.METHOD: This cross-sectional descriptive study utilizes the self-report survey method. The survey questionnaires were completed by 50 and 52 nurses working in intensive care units and general units, respectively. The instrument, which consisted of 16 items of ethical dilemma situations about treatment decision and confidentiality, was used. The mean scores for each item were compared between the two groups.RESULTS: The study found no differences in terms of age, gender, education level, clinical experience in years, and being educated on healthcare ethics. For 9 out of 16 items, the mean scores of nurses in intensive care units were significantly higher than those of nurses in general units.CONCLUSION: Nurses in intensive care units experienced ethical dilemmas regarding treatment decisions and confidentiality more often than those in general units. This study emphasizes the need to establish strategies for improving the ethical competence of critical care nurses.
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Confidentiality , Critical Care , Delivery of Health Care , Education , Ethics , Intensive Care Units , Mental Competency , Methods , Surveys and QuestionnairesABSTRACT
Since the implementation of the new healthcare reform,it has achieved some success.However,many problems still exist in the process of primary medical reform,and there are many ethical dilemmas.The un-balanced allocation of medical resources reflects the relationship between government and market,the difficult pro-motion of " three medicine" reflects the sectoral conflicts of interest,the difficult implementation of the grading di-agnosis and treatment system reflects the different demands of stakeholders in health care system.As a result,the whole function of China's medical and health system has not been fully played.Based on the ethical perspective,this paper put forward that taking the scientific definition of government and market responsibility as a framework,it should construct an investment system of health resource allocation taking equity as a value orientation; taking ethi-cal responsibility as the framework,it should promote the cooperation consensus of the linkage reform of medical treatment,medical insurance and medical departments; and taking ethical community as the constraint,it should balance the interests of all parties and promote the implementation of the policy of grading treatment system.
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Social work as one type of practical work for pursuing moral practice,ideology and social value play an important restraint role in its professional ethical choice. In the work of social work intervened in the service of elderly dying patients, the realization of owner' s right is subject to institutional regulation, disputes of family interest, conflicts of social value and the alienation of ethical environment, causing that social workers fall into an ethical dilemma in practice. In order to solve this ethical dilemma, medical social workers can work together to reshape the construction of a new ethical system for elderly hospice care by strengthening their own guiding ability, promoting the education of ethics and optimizing the environment of ethical choice.
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This paper summarized the current ethical dilemmas of living will in our country including life ethical dilemmas, medical ethical dilemmas and family ethical dilemmas, and then proposed several suggestions for the promotion of living will in China:strengthening the theoretical research on related contents of living will, increasing the intensity of death education, carrying out related activities in the communities, strengthening the policy support and establishing hospital or regional pilots, to provide the feasible problems for the advancement of our country's living will.
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Practice teaching and supervision has become an important part of hospital social work practice, and the handling and response to internship dilemma is the problem that every institution supervisor needs to think a-bout. Based on qualitative interview and text analysis, starting from the needs of intern, this paper found that students of social work major mainly faced the following dilemma in the process of hospital practice: role adapta-tion, the dilemma of professional practice, the dilemma of ethical relationship and practice burnout and so on. Combined with their own supervision experience, this paper put forward coping methods.
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Health science popularization industrialization is a necessary choice for the development of health popularization business.However,in the process of health science popularization industrialization,there exists certain difficulties to balance the contradiction between profitability and public welfare.In theory,the public welfare goal of health science popularization can be realized by industrial profitability means;therefore,the ethical dilemma about it can be solved.In the policy practice,the government may be the main body of the health popularization while profit-making organizations may carry out the health popularization.The government can promote the health popularization industrialization by purchasing health popularization from the relative organizations.
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Through investigating the hospital admission and hospital discharge of vagrant mental patients in Xi-aoshan Hospital from January 2011 to December 2015 , the present study found that there existed some ethical di-lemmas including the risk ofdiagnosing mental disorder but actually not, lack of the guarantee of patients' rights and interests and supervision mechanism without guardian, long-term retention in the wards, and so on. It is sug-gested to establish right protection and supervision committee for vagrant mental patients, reduce the misdiagnosis ofdiagnosing mental disorder but actually not through the error correction mechanism, ensure proper treatment and care, create retention way, protect the basic rights of the vagrant mental patients, reduce mental disability, avoid to stray again, so as to perfect the social management system.
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First of all, this paper discussed the ethical dilemmas of hospice care from four aspects. Secondly, it deeply analyzed the reasons of the ethical dilemmas in view of life ethics, medical ethics, family ethics and social ethics, etc. Finally, aiming at these ethical dilemmas and reasons, it put forward the concrete countermeasures to the terminally ill persons, medical staffs, family members, the government and the social public that related to hos-pice career, in the hope of promoting the development of hospice career.
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Organ donation for transplantation raises ethical dilemmas which demand a response from an anthropological vision respectful of the human person and his dignity. The ethical principles that should be respected primarily are: the defense of physical life, self-determination and non-instrumentalization of human beings. The act of donation is essentially altruistic and, as such, cannot be mandatory; consent process shall be ethically valid if it contains sufficient information and if is signed by a competent person, free of coercion. In the case of living donors, the act shall be lawful if there is an adequate relationship between the risks for the donor and the expected benefits for the recipient. Deceased organ donation occurs in two circumstances, when death is certified by neurological criteria (brain death) or by cardiovascular criterion (circulatory death); the latter usually occurs in critically ill patients in whom it has been decided to limit the therapeutic effort withdrawing life support measures. In decision-making at the end of life, physicians should always pursue the good of the patient, regardless of their status as potential donor; also, the medical team must have reasonable certainty that death has occurred when removing the organs. The person must always be treated as an end in itself and never as a mere means for obtaining other purposes, however laudable they may be.
La donación de órganos para trasplantes plantea dilemas éticos cuya respuesta demanda una visión antropológica respetuosa de la persona humana y su dignidad. Los principios éticos que deberían respetarse primariamente son: la defensa de la vida física, la autodeterminación y la no-instrumentalización del ser humano. El acto de donación es esencialmente altruista y, como tal, no puede ser obligatorio; el proceso de consentimiento será éticamente válido si es informado, suscrito por una persona competente y libre de coacción o coerción. En el caso del donante vivo, el acto será lícito en la medida que exista una relación adecuada entre los riesgos a que se somete el donante y los beneficios esperados para el receptor. La donación de órganos por alguien ya fallecido ocurre en dos circunstancias, según si la muerte se certifica mediante criterio neurológico (muerte encefálica) o por criterio cardiovascular (muerte circulatoria o en asistolía); este último caso ocurre habitualmente en pacientes críticos en quienes se ha decidido limitar el esfuerzo terapéutico suspendiendo medidas de soporte vital. Un correcto actuar médico siempre debe privilegiar el bien del paciente en la toma de decisiones al final de la vida, con independencia de su condición de potencial donante; asimismo, el equipo médico debe tener razonable certeza que la muerte ya ha ocurrido al momento de extraer los órganos. La persona debe ser tratada siempre como un fin en sí misma y nunca como mero medio para la obtención de otros fines, por muy loables que éstos sean.
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Humans , Brain Death , Ethical Analysis , Organ Transplantation , Personhood , Tissue and Organ ProcurementABSTRACT
La transformación del sistema de salud colombiano a partir de la Ley 100/1993 planteó nuevos conflictos éticos a los médicos. Como parte de una tesis doctoral cuyo objetivo general era comprender las tensiones que emergen entre los tipos de clima ético organizacional y los conflictos éticos que se presentan a médicos y enfermeros en tres instituciones prestadoras de salud (IPS) de Bogotá, se propuso identificar y describir los conflictos éticos que se presentan a los médicos y la manera como los resuelven, para que fuera posible indagar si desde los comités de ética pueden resolverse estos conflictos, como ha sido sugerido por algunos bioeticistas. Para ello se realizaron 23 entrevistas a médicos que laboraban en tres centros hospitalarios con servicios de alta complejidad de Bogotá: uno público, uno privado y uno de un régimen especial. Los resultados sugieren la presencia de conflictos de interés, por una parte, y conflictos de obligación que se expresan como dilemas éticos y angustia moral, por otra. Con base en ello, se formulan recomendaciones para la formación profesional, la investigación y los comités de ética hospitalarios.
The transformation of the Colombian health system from the 100/1993 law raised new ethical conflicts to physicians. As a part of a doctorate thesis oriented to understand emerging tensions among ethical climate and ethical conflicts faced by physicians and nurses in three hospitals located in Bogota, it was proposed to identify and describe the ethical conflicts presented to physicians and the way they are faced. In order to achieve this goal, 23 interviews were carried out with physicians who worked in three hospitals located in Bogota: one private, one public and one with a special regime. The results suggest the presence of interest conflicts on the one hand, and commitment conflicts expressed as ethical dilemmas and moral distress on the other. Based on these results, recommendations to physicians education, research and committees of ethics are suggested.
A transformação do sistema de saúde colombiano a partir da Lei 100/1993 levantou novos conflitos éticos para os médicos. Como parte de uma tese de doutorado cujo objetivo geral foi compreender as tensões que surgem entre os tipos de clima ético organizacional e os conflitos éticos apresentados aos médicos e enfermeiros em três instituições de saúde (IPS) em Bogotá, propôs-se a identificar e descrever os conflitos éticos apresentados aos médicos e como eles os resolvem, para que seja possível pesquisar si a partir dos comitês de ética esses conflitos podem se resolver, como foi sugerido por alguns bioeticistas. Para isso foram realizadas 23 entrevistas com médicos que trabalhavam em três centros hospitalares com serviços de alta complexidade de Bogotá: um público, um privado e um de regime especial. Os resultados sugerem da presença de conflitos de interesses, por um lado, e conflitos de obrigação que são expressos como dilemas éticos e sofrimento moral, do outro lado. Com base nisso, são formuladas recomendações para a formação profissional, a investigação e os comitês de ética hospitalares.
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Humans , Bioethics , Ethics, Medical , MoralsABSTRACT
PURPOSE: This study was done to develop a realistic clinical case and investigate nurses' decision-making about nurses' ethical dilemmas with physicians in the fields of nursing practice. METHODS: Case development and a hypothetical case study were used. Participants were 52 nurses. Data were collected in 2012 and 2013 using an open-ended questionnaire and interviews and analyzed using content analysis and descriptive statistics. RESULTS: Various dilemma situations between nurses and physicians, such as violence, deathbed, medication-prescription, and physicians' incapacity-unfairness, were suggested. A clinical dilemma case about medication-prescription was developed based on nurses' experiences. Nurses' responses to the developed case situation and responses were classified into five types. Various reasons were given for making the decisions and about 56% of the nurses decided to notify their supervisor without deleting nursing records. CONCLUSION: In this study, a realistic clinical dilemma case was developed, and nurses' ethical decision making was identified. These findings can be used in developing effective strategies for nurses to solve ethical dilemmas and to improve ethical decision-making abilities.
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Decision Making , Ethics, Nursing , Nursing , Nursing Records , Surveys and Questionnaires , ViolenceABSTRACT
El concepto de ética está basado en reglas y principios que rigen el comportamiento del individuo de modo consciente y libre. La odontología enfrenta dilemas por las interacciones odontólogo-paciente, el acceso a la salud dental, aumento del número de profesionales; los cuales se debe abordar sobre la base de las prácticas éticas inherentes al ejercicio profesional. El objetivo del trabajo fue describir el nivel de conocimientos, actitudes y prácticas sobre el Código de Ética Odontológica, para lo que se aplicó un cuestionario en 102 odontólogos de la Policía Nacional en el año 2009, a quienes reunían los criterios de inclusión, sin límite de edad y que accedieron a participar del estudio. Se realizó un estudio observacional descriptivo de corte transverso. El 48% de los evaluados tuvo conocimiento suficiente del Código de Ética Odontológico, más del 80% demostró actitud positiva y el 94% ejecutó prácticas que condicen con las normas establecidas en dicho Código; lo que concuerda con los valores que guían a los profesionales y el proceder racional como ser humano.
The concept of ethics is based on rules and principles governing the behavior of the individual consciously and freely. Odontology faces dilemmas because of the odontologist-patient interactions, access to dental health, and increased number of professionals which should be addressed on the basis of ethical practices inherent to the professional practice. The objective was to describe the level of knowledge, attitudes and practices of the Code of Odontologic Ethics for which a questionnaire was applied to 102 odontologists of the National Police in 2009 who met the inclusion criteria, without limit of age and agreed to participate. An observational descriptive cross-sectional study was performed. Forty eight percent of the evaluated people had sufficient knowledge of the Code of Odontological Ethics, more than 80% showed positive attitude and 94% implemented practice that fits with the standards established in the Code, which is consistent with the values that guide professionals and the rational procedure as a human being.
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Ethical Analysis , Codes of Ethics , Bioethical Issues , Clinical ClerkshipABSTRACT
Objective To explore nurses' experiences of ethics dilemma and coping strategies involed in caring dying patients. Methods Interviews were conducted with 25 nurses from four different levels of hospitals in Shanghai. Results The ethical dilemmas that participants encountered with were derived from different standpoint and ethics decision-making between "relieve pain" and "extend life span","life value" and "insufficient medical resources","agent execution for patients' rights of being informed consent" and"medical intervention rights". Nurses' coping strategies included patiently communicating with family members to achieve agreement,failing to change family's decision then passively accepting it by self-adjustment,and following hospital rules and regulation or relying on team decision-making. Conclusion The study analyzed and discussed the reasons behind ethical dilemmas,as well as providing some suggestions on how to improve the coping abilities for nurse staffs. It can provide reference and basis for ethical decision-making.
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This main purpose of this study was to assess the effects of two different types of ethics education on the moral judgement of clinical nurses. One type was free discussions among nurses with given specific moral issues and the other type was discussions guided by experts on specific moral issues. The study employed a quasi-experimental, nonequivalent pre test-post test design using two different control groups. The conceptual framework of the study was derived from the Kohlberg's Moral Development Theory (1969) and the Greipp's Ethical Decision-Making Model (1992). The data was collected during the period of October 14 through December 15, 1998. Sample consists of 32 nurses working in the ICU who met research criteria. 16 nurses were assigned to the free discussion group and 16 nurses to the group for the guided discussion with experts group. For the pre-test, the DIT which was developed by Rest (1984) and JAND by Ketefian (1998) were used with some modification by the author. After the education, only JAND was used to assess the changes in moral judgement. The collected data was analysed using SPSS PC program. The findings are as follows: 1. There was no significant difference between two groups in their general characteristics. Only difference which was statistically significant between two groups was that realistic score on Case 3/Medical Research and Autopsy was higher in the free discussion group. 2. Hypothesis 1: "There will be a difference on the moral judgement of nurses before and after they receive an ethics education". This hypothesis was supported partially. Those who had low scores on moral judgement before the education tended to have higher scores after the education on the same issues. And, after the education, the nurses tend to give lower scores on the dilemmas they had experienced frequently at work; while giving higher scores on those dilemmas they had no prior experience. 3. Hypothesis 2: "The effect of education may differ depended upon the moral development index [P(%)] score of nurses". The effect of education was different depend on moral development level. The group who's P(%) scores was low at the pretest has higher scores in realistic moral judgement after the education, while the groups with middle or high P(%) scores went down after the education. These changes were statistically significant in some cases, thus, the Hypothesis 2 was partially supported 4. Hypothesis 3: "The method of ethics education will have different effects on the moral judgement of nurses". Even though several nurses attended the guided discussion stated that the education program broadend their perspectives the difference between two groups was not significant and this hypothesis was not supported. In conclusion, both types of ethics education had helped the nurses to acquire the skills to deal some nursing dilemmas. The effects of ethics education may differ according to the moral development index - P(%) score. However, because of some of the limitations of this study, mainly small sample size, short term education, unable to control other variables which may affect moral judgement of nurses, further research is warranted.