Medical futility at the end of life: the first qualitative study of ethical decision-making methods among Turkish doctors.

IF 3 1区 哲学 Q1 ETHICS
Esra Aksoy, Ilhan Ilkilic
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引用次数: 0

Abstract

Background: The swift advancement of intensive care medicine, coupled with technological possibilities, has prompted numerous ethical inquiries regarding decision-making processes concerning the withholding or withdrawal of treatment due to medical futility. This study seeks to delineate the decision-making approaches employed by intensive care physicians in Türkiye when faced with medical futility at the end of life, along with an ethical evaluation of these practices.

Methods: Grounded theory, a qualitative analysis method was employed, conducting semi-structured, in-depth interviews with eleven intensive care physicians in Türkiye. The subsequent text analysis was carried out using MAXQDA software.

Results: Participants assert that the decisions made by Turkish physicians determine whether treatment is futile, rely on medical consensus, and lack a standardized decision-making process. The decisions are influenced by legal and social pressures, resource constraints, and occasional conflicts of interest. The significance of professional hierarchy is notable, with limited consideration given to the opinions of nurses and other staff. The unstructured medical consensus processes are shaped by normative concepts such as benefit, age, justice, and conscience. Furthermore, it was observed that the conscientious opinions of physicians carry more weight than adherence to ethical principles and guidelines.

Conclusion: To create optimal conditions for doctors to make ethically justifiable decisions, the dynamics within the treatment team should be improved, emphasizing the minimization of hierarchy, and ensuring the active participation of all team members in the decision-making process. Additionally, efforts should be directed toward narrowing the gap between the conscience of the individual doctor and established ethical principles. A potential solution lies in the nationwide implementation of clinical ethics committees and the establishing of clinical ethics guidelines, aiming to address, and overcome the identified challenges.

生命末期的医疗无用论:土耳其医生伦理决策方法的首次定性研究。
背景:随着重症监护医学的迅速发展以及技术的进步,人们对因医疗无效而暂停或撤消治疗的决策过程提出了许多伦理问题。本研究旨在探讨土耳其重症监护医生在生命末期面对医疗无效时所采用的决策方法,并对这些做法进行伦理评估:研究采用了基础理论这一定性分析方法,对 11 名土耳其重症监护医生进行了半结构化的深度访谈。随后使用 MAXQDA 软件进行文本分析:结果:参与者认为,土耳其医生在决定治疗是否无效时,依赖于医学共识,缺乏标准化的决策过程。这些决定受到法律和社会压力、资源限制以及偶尔出现的利益冲突的影响。专业等级制度的重要性显而易见,对护士和其他工作人员的意见考虑有限。利益、年龄、公正和良知等规范性概念决定了非结构化的医学共识过程。此外,据观察,医生的良心意见比遵守伦理原则和指导方针更有份量:结论:为了给医生做出符合伦理的决定创造最佳条件,应改善治疗团队内部的动态关系,强调尽量减少等级制度,并确保团队所有成员积极参与决策过程。此外,还应努力缩小医生个人良知与既定伦理原则之间的差距。一个潜在的解决方案是在全国范围内建立临床伦理委员会,并制定临床伦理指南,以应对和克服所发现的挑战。
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
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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