Anna Lisa Westermair, Stella Reiter-Theil, Sebastian Wäscher, Manuel Trachsel
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Here, we present findings on patient characteristics and ethical concerns.</p><p><strong>Findings: </strong>The ECs typically concerned an intensely pretreated, extremely underweight AN patient endangering herself by refusing the proposed treatment. In addition to the justifiability of coercion, frequent ethical concerns were whether further coerced treatment aimed at weight gain would be ineffective or even harmful, evidencing uncertainty about beneficence and non-maleficence and a conflict between these principles. Discussed options included harm reduction (e.g. psychotherapy without weight gain requirements) and palliation (e.g. initiating end-of-life care), the appropriateness of which were ethical concerns in themselves. Overall, nine different types of conflicts between or uncertainties regarding ethical principles were identified with a median of eight per case.</p><p><strong>Conclusions: </strong>Ethical concerns in caring for persons with AN are diverse and complex. To deal with uncertainty about and conflict between respect for autonomy, beneficence and non-maleficence, healthcare professionals consider non-curative approaches. 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引用次数: 0
摘要
背景:医护人员在护理神经性厌食症(AN)患者的过程中会面临很大的道德压力。主要的道德冲突被认为是为防止过早死亡等严重并发症而采取强制措施与接受治疗拒绝之间的冲突。然而,有关这一主题的实证证据却很少:我们从瑞士的一家临床伦理支持服务机构中找到了所有 19 份关于 AN 的伦理咨询(EC)文件。我们采用演绎-归纳的顺序方法对这些文件进行了编码,并以病例为基础对编码系统进行了解释。在此,我们将介绍有关患者特征和伦理问题的研究结果:EC通常涉及一名接受过严格预处理、体重极度不足的AN患者因拒绝建议的治疗而危及自身。除了强迫治疗的合理性外,经常出现的伦理问题还包括进一步的强迫治疗是否会对体重增加无效甚至有害,这证明了受益原则和非受益原则的不确定性以及这些原则之间的冲突。讨论过的方案包括减少伤害(如不要求体重增加的心理治疗)和缓解(如启动临终关怀),这些方案是否合适本身就是伦理问题。总体而言,共发现了九种不同类型的伦理原则冲突或不确定性,每个病例的中位数为八种:护理 AN 患者的伦理问题多种多样,十分复杂。为了应对尊重自主性、受益性和非受益性之间的不确定性和冲突,医护人员会考虑采取非治疗性的方法。然而,目前在一般合理性、资格标准和具体方案方面的不确定性阻碍了这些方法的采用。
Ethical concerns in caring for persons with anorexia nervosa: content analysis of a series of documentations from ethics consultations.
Background: Caring for patients with anorexia nervosa (AN) is associated with high levels of moral distress among healthcare professionals. The main moral conflict has been posited to be between applying coercion to prevent serious complications such as premature death and accepting treatment refusals. However, empirical evidence on this topic is scarce.
Methods: We identified all 19 documentations of ethics consultations (ECs) in the context of AN from one clinical ethics support service in Switzerland. These documentations were coded with a sequential deductive-inductive approach and the code system was interpreted in a case-based manner. Here, we present findings on patient characteristics and ethical concerns.
Findings: The ECs typically concerned an intensely pretreated, extremely underweight AN patient endangering herself by refusing the proposed treatment. In addition to the justifiability of coercion, frequent ethical concerns were whether further coerced treatment aimed at weight gain would be ineffective or even harmful, evidencing uncertainty about beneficence and non-maleficence and a conflict between these principles. Discussed options included harm reduction (e.g. psychotherapy without weight gain requirements) and palliation (e.g. initiating end-of-life care), the appropriateness of which were ethical concerns in themselves. Overall, nine different types of conflicts between or uncertainties regarding ethical principles were identified with a median of eight per case.
Conclusions: Ethical concerns in caring for persons with AN are diverse and complex. To deal with uncertainty about and conflict between respect for autonomy, beneficence and non-maleficence, healthcare professionals consider non-curative approaches. However, currently, uncertainty around general justifiability, eligibility criteria, and concrete protocols hinders their adoption.
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.