乌干达临床伦理咨询探索:乌干达癌症研究所案例研究。

IF 3 1区 哲学 Q1 ETHICS BMC Medical Ethics Pub Date : 2024-08-09 DOI:10.1186/s12910-024-01085-1
Mayi Mayega Nanyonga, Paul Kutyabami, Olivia Kituuka, Nelson K Sewankambo
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引用次数: 0

摘要

导言:在全球范围内,医疗服务提供者(HCPs)、医院管理者、患者及其护理人员在临床护理过程中越来越多地面临复杂的道德、社会、文化、伦理和法律困境。在高收入国家(HICs),正规和非正规的临床伦理支持服务(CESSs)被用来解决 HCPs、患者及其家属之间的生物伦理冲突。在包括乌干达在内的大多数非洲国家,有关解决这些问题的机制以及利用这些机制的利益相关者的经验和观点的证据十分有限:这项现象学定性研究采用深入访谈(IDI)和焦点小组讨论(FGD)的方法,从乌干达癌症研究所(UCI)的工作人员、患者和护理人员中收集数据。对数据进行了演绎和归纳分析,得出的主题和次主题被用于编制编码手册:研究显示,加州大学洛杉矶分校没有专门解决伦理困境的正式委员会或机制。取而代之的是在六个论坛上解决伦理困境:个人咨询、肿瘤委员会会议、发病率和死亡率会议(MMMs)、核心管理会议、奖惩委员会会议和临床科室会议。由于这些论坛的议程与伦理无关,而且论坛成员缺乏医学伦理培训和有效解决伦理困境的必要经验,与会者对这些论坛的效果表示担忧:美国加州大学洛杉矶分校用于解决伦理困境的论坛是隐性的,涉及在没有精通医学或临床伦理学的人员指导下通过各种结构做出的决定。与会者强烈建议成立一个多学科临床伦理委员会,其成员应接受过医学和临床伦理方面的培训,具备相关技能和经验。
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Exploration of clinical ethics consultation in Uganda: a case study of Uganda Cancer Institute.

Introduction: Globally, healthcare providers (HCPs), hospital administrators, patients and their caretakers are increasingly confronted with complex moral, social, cultural, ethical, and legal dilemmas during clinical care. In high-income countries (HICs), formal and informal clinical ethics support services (CESSs) have been used to resolve bioethical conflicts among HCPs, patients, and their families. There is limited evidence about mechanisms used to resolve these issues as well as experiences and perspectives of the stakeholders that utilize them in most African countries including Uganda.

Methods: This phenomenological qualitative study utilized in-depth interviews (IDIs) and focus group discussions (FGDs) to collect data from Uganda Cancer Institute (UCI) staff, patients, and caretakers who were purposively selected. Data was analyzed deductively and inductively yielding themes and sub-themes that were used to develop a codebook.

Results: The study revealed there was no formal committee or mechanism dedicated to resolving ethical dilemmas at the UCI. Instead, ethical dilemmas were addressed in six forums: individual consultations, tumor board meetings, morbidity and mortality meetings (MMMs), core management meetings, rewards and sanctions committee meetings, and clinical departmental meetings. Participants expressed apprehension regarding the efficacy of these fora due to their non-ethics related agendas as well as members lacking training in medical ethics and the necessary experience to effectively resolve ethical dilemmas.

Conclusion: The fora employed at the UCI to address ethical dilemmas were implicit, involving decisions made through various structures without the guidance of personnel well-versed in medical or clinical ethics. There was a strong recommendation from participants to establish a multidisciplinary clinical ethics committee comprising members who are trained, skilled, and experienced in medical and clinical ethics.

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来源期刊
BMC Medical Ethics
BMC Medical Ethics MEDICAL ETHICS-
CiteScore
5.20
自引率
7.40%
发文量
108
审稿时长
>12 weeks
期刊介绍: BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.
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