Ethical challenges in health care during collective hunger strikes in public or occupied spaces

IF 1.7 2区 哲学 Q2 ETHICS Bioethics Pub Date : 2024-05-17 DOI:10.1111/bioe.13306
Dominik Haselwarter, Katja Kuehlmeyer, Verina Wild
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Abstract

Public collective hunger strikes take place in complex social and political contexts, require medical attention and present ethical challenges to physicians. Empirical research, the ethical debate to date and existing guidelines by the World Medical Association focus almost exclusively on hunger strikes in detention. However, the public space differs substantially with regard to the conditions for the provision of health care and the diverse groups of healthcare providers or stakeholders involved. By reviewing empirical research on the experience of health professionals with public collective hunger strikes, we identified the following ethical challenges: (1) establishment of a trustful physician–striker relationship, (2) balancing of medico-ethical principles in medical decision-making, (3) handling of loyalty conflicts and (4) preservation of professional independence and the risk of political instrumentalization. Some of these challenges have already been described and discussed, yet not contextualized for public collective strikes, while others are novel. The presence of voluntary physicians may offer opportunities for a trustful relationship and, hence, for ethical treatment decisions. According to our findings, it requires more attention to how to realise autonomous medical decisions in the complex context of a dynamic, often unstructured and politically charged setting, which ethical norms should shape the professional role of voluntary physicians, and what is the influence of the hunger strikers' collective on individual healthcare decisions. Our article can serve as a starting point for further ethical discussion. It can also provide the basis for the development of potential guidelines to support health professionals involved in public collective hunger strikes.

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在公共场所或被占领场所集体绝食期间的医疗保健伦理挑战。
公众集体绝食发生在复杂的社会和政治背景下,需要医疗关注,并对医生提出了伦理挑战。经验研究、迄今为止的伦理辩论和世界医学协会的现有指导方针几乎完全侧重于拘留所中的绝食。然而,在提供医疗服务的条件以及所涉及的不同医疗服务提供者或利益相关者群体方面,公共空间存在很大差异。通过回顾有关医疗专业人员参与公共集体绝食行动经验的实证研究,我们发现了以下伦理挑战:(1)建立医生与绝食者之间的信任关系,(2)在医疗决策中平衡医学伦理原则,(3)处理忠诚冲突,以及(4)维护专业独立性和政治工具化风险。其中一些挑战已被描述和讨论过,但没有结合公共集体罢工的背景,而另一些挑战则是新的。自愿医生的存在可能会为建立信任关系提供机会,从而为做出合乎道德的治疗决定提供机会。根据我们的研究结果,需要更多地关注如何在一个动态的、往往是非结构化的、充满政治色彩的复杂环境中实现自主的医疗决策,哪些道德规范应塑造志愿医生的专业角色,以及绝食者集体对个人医疗决策的影响。我们的文章可以作为进一步伦理讨论的起点。它还可以为制定潜在的指导方针提供依据,以支持参与公共集体绝食斗争的医疗专业人员。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Bioethics
Bioethics 医学-医学:伦理
CiteScore
4.20
自引率
9.10%
发文量
127
审稿时长
6-12 weeks
期刊介绍: As medical technology continues to develop, the subject of bioethics has an ever increasing practical relevance for all those working in philosophy, medicine, law, sociology, public policy, education and related fields. Bioethics provides a forum for well-argued articles on the ethical questions raised by current issues such as: international collaborative clinical research in developing countries; public health; infectious disease; AIDS; managed care; genomics and stem cell research. These questions are considered in relation to concrete ethical, legal and policy problems, or in terms of the fundamental concepts, principles and theories used in discussions of such problems. Bioethics also features regular Background Briefings on important current debates in the field. These feature articles provide excellent material for bioethics scholars, teachers and students alike.
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