A qualitative study of the ethical issues encountered at end-of-life care at a university teaching hospital in Nigeria.

IF 3.4 2区哲学 Q1 ETHICS

Journal of Medical Ethics Pub Date : 2025-10-17 DOI:10.1136/jme-2024-110101

Nnenma Ndidiamaka Udeh, Ngozi Idemili Aronu, Emmanuel R Ezeome

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Abstract

Background: End-of-life (EOL) care involves providing quality medical attention to the dying patient. It is fraught with some ethical challenges, often underexplored in African settings. This communication presents a qualitative analysis of ethical issues encountered by caregivers and their patients receiving EOL care in a teaching hospital in Nigeria.

Methods: Ethical issues in EOL care encountered by 40 people (dying patients, their families, nurses and doctors) at the University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria, were explored over 2 months. The participants' sociodemographic data were analysed using descriptive statistics, while qualitative data were analysed using a thematic framework. The transcripts were coded using NVivo V.12 software.

Results: All participant groups encountered commonly reported ethical challenges in EOL care, including issues of medical futility, treatment refusal, truthful disclosures, families requesting that a competent patient not be informed about their condition, confidentiality, limiting or withdrawing a treatment, limited or insufficient pain management, conflicting interests in care, an unfair financial burden without the patient consent and an unfair burden on the healthcare system. Additionally, the uncommon issues included the patient's unwillingness to discuss their terminal status, families withdrawing due care and support prematurely and delayed referrals.

Conclusion: Ethical issues are commonly encountered in caring for the patient at EOL in the Nigerian environment, notwithstanding the paucity of literature on them. This underscores the importance of adopting known preventive measures to eliminate or minimise these issues.

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对尼日利亚一所大学教学医院临终关怀中遇到的伦理问题进行定性研究。

背景：临终关怀包括为临终病人提供高质量的医疗照顾。它充满了一些道德上的挑战，而这些挑战在非洲往往没有得到充分的探索。本报告对尼日利亚一家教学医院的护理人员及其接受EOL护理的患者所遇到的伦理问题进行了定性分析。方法：对尼日利亚埃努古州埃努古市尼日利亚大学教学医院40例（临终病人、家属、护士和医生）在EOL护理中遇到的伦理问题进行为期2个月的调查。参与者的社会人口统计数据使用描述性统计进行分析，而定性数据使用专题框架进行分析。转录本使用NVivo V.12软件编码。结果：所有参与者群体在EOL护理中都遇到了常见的伦理挑战，包括医疗无效、拒绝治疗、真实披露、家属要求不告知有能力的患者其病情、保密、限制或撤销治疗、有限或不充分的疼痛管理、护理中的利益冲突、未经患者同意的不公平经济负担以及医疗保健系统的不公平负担。此外，不常见的问题包括患者不愿意讨论他们的临终状态，家属过早地撤回应有的照顾和支持，以及延迟转诊。结论：伦理问题是经常遇到的护理病人在EOL在尼日利亚的环境中，尽管缺乏文献。这强调了采取已知的预防措施以消除或尽量减少这些问题的重要性。

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

Journal of Medical Ethics 医学-医学：伦理

CiteScore

7.80

自引率

9.80%

发文量

164

审稿时长

4-8 weeks

期刊介绍： Journal of Medical Ethics is a leading international journal that reflects the whole field of medical ethics. The journal seeks to promote ethical reflection and conduct in scientific research and medical practice. It features articles on various ethical aspects of health care relevant to health care professionals, members of clinical ethics committees, medical ethics professionals, researchers and bioscientists, policy makers and patients. Subscribers to the Journal of Medical Ethics also receive Medical Humanities journal at no extra cost. JME is the official journal of the Institute of Medical Ethics.