Funda Gülay KADIOĞLU, Rana CAN, Nuri Selim KADIOĞLU, ÖNER Sibel YALÇIN, Selda OKUYAZ

Physicians’ attitudes toward clinical ethics consultation: a research study from Turkey

Amaç: Çalışmamızın amaçları hekimlerin etik danışmanlık talep etme ya da etmeme gerekçelerini saptamak ve danışmanlık talebinde hangi etik sorunlara öncelik verildiğini belirlemektir. Yöntem ve gereç: Bu araştırma katılımcı tarafından doldurulan bir anket uygulanarak gerçekleştirilmiş ve üç ayrı tıp fakültesi hastanesinde görev yapmakta olan 270 klinisyen (cerrah ve dâhiliyeci) bu araştırmaya dâhil edilmiştir. Anket, etik konsültasyonu talep etme ya da talep etmeme gerekçeleriyle ilişkili Likert türünde ifadeler içeren bir bölümden ve hekimlerin öncelemelerine göre etik sorunların sıralandığı bir listeden oluşmaktadır. Bulgular: Araştırmaya katılan klinisyenlerin % 40,4’ü cerrahi bölümünde, % 59,6’sı ise dahiliye bölümünde görev yapmaktadır. Hekimlerin çoğunluğu (% 90) etik danışmanlık talebinde bulunmak istediklerini belirtmiştir. Etik danışmanlık talebi için cerrahların ilk gerekçesi “hukuki bir sorunda yardımcı olması” iken, dâhiliyecilerin ilk gerekçesi “vicdani rahatlık” olmuştur (P > 0,05). Etik danışmanlık talep eden klinisyenlerin öncelik verdikleri başlıca etik sorun ise “yaşam destek sisteminin kapatılması kararı” olmuştur. Sonuç: Bu çalışmadan elde edilen sonuçlar klinisyenlerin etik danışmanlığa gereksinim duyduğunu göstermektedir. Ancak yine de sınırlı sayıda danışmanlık talebinde bulunulduğu ve uygulamada yeterli bir tecrübenin söz konusu olmadığı da bir gerçektir. Bu durumu ülkemizdeki klinik etik danışmanlıkla ilgili birimlerin eksikliği ile açıklamak olanaklıdır.

Hekimlerin klinik etik danışmanlığına ilişkin tutumları: Türkiye’den bir araştırma çalışması

Aim: To identify the reasons why physicians request or do not request ethics consultation and to determine the priority of ethical issues for those demanding consultation. Materials and methods: This survey was conducted using a self-administered questionnaire, and 270 clinicians (surgeons and internists) from 3 different medical school hospitals were included. The questionnaire consisted of Likerttype statements related to the reasons for requesting or not requesting ethics consultation and a ranking list of ethical dilemmas according to the physicians’ priorities. Results: Of all clinicians, 40.4% were employed in surgical departments and 59.6% in internal medicine departments. Most of the physicians (90%) stated that they wanted to demand ethics consultations. The first reason surgeons gave for demanding consultation was a desire to receive help with judicial problems; among internists, the most common reason for demanding a consultation was to achieve a clear conscience (P > 0.05). “Withdrawal of life-support-system decision” was determined to be the main subject for which clinicians requested ethics consultations. Conclusion: The results of this study indicate that clinicians require ethics consultations; nevertheless, it is a fact that there is a limited number of requests and inadequate experience with applying. This situation may be caused by the lack of clinical ethics support services that deal with ethics consultation in Turkey.

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1. American Society for Bioethics and Humanities. Core competencies for health care ethics consultation: the report of the American Society for Bioethics and Humanities. Glenview (IL): ASBH; 1998.
2. Aulisio M. Meeting the need, ethics consultation in health care today. In: Aulisio MP, Arnold RM, Younger SJ, editors. Ethics Consultation from Theory to Practice. Baltimore: The Johns Hopkins University Press; 2003.
3. Singer PA, Pellegrino ED, Siegler M. Ethics committees and consultants. J Clinical Ethics 1991; 1: 263-7.
4. Singer P, Pellegrino ED, Siegler M. Clinical ethics revisited. BMC Medical Ethics 2001; 2: 1-8.
5. DuVal G, Sartorius L, Clarridge B, Gensler G, Danis M. What triggers requests for ethics consultations? J Med Ethics 2001; 27: 24-9.
6. Hurst SA, Hull SC, DuVal G, Danis M. How physicians face ethical diffi culties: a qualitative analysis. J Med Ethics 2005; 31: 7-14.
7. La Puma J, Stocking CB, Silverstein MD, DiMartini A, Siegler M. An ethics consultation service in a teaching hospital: utilization and evaluation. JAMA 1988; 260: 808-811.
8. La Puma J, Stocking CB, Darling CA, Siegler M. Community hospital ethics consultation: evaluation and comparison with a university hospital service. American Journal of Medicine 1992; 9: 346-351.
9. La Puma J, Schiedermayer DL. Ethics committees, due process, and compassion. Ann Intern Med 1994; 121: 386-387.
10. Davies L, Hudson LD. Why don’t physicians use ethics consultation? J Clinical Ethics 1999; 10: 116-25.
11. Reiter-Theil S. Ethics consultation on demand: concepts, practical experiences and a case study. J Med Ethics 2000; 26: 198-203.
12. Reiter-Theil S. The Freiburg approach to ethics consultation: process, outcome and competencies. J Med Ethics 2001; 27:21- 23.
13. Slowther A, Bunch C, Woolnough B, Hope T. Clinical ethics support services in the UK: an investigation of the current provision of ethics support to health professionals in the UK. J Med Ethics 2001; 27: 2-8.
14. Slowther A, Bunch C, Woolnough B, Hope T. Clinical ethics support in the UK: a review of the current position and likely development. London: Nuffi eld Trust; 2001.
15. DuVal G, Clarridge B, Gensler G, Danis M. A national survey of U.S. internists’ experiences with ethical dilemmas and ethics consultation. J Gen Intern Med 2004; 19: 251-258.
16. Godkin MD, Faith K, Upshur REG, MacRae SK, Tracy CS, PEECE Group. Project Examining Effectiveness in Clinical Ethics (PEECE): phase 1-descriptive analysis of nine clinical ethics services. J Med Ethics 2005; 31: 505-512.
17. Gacki-Smith J, Gordon E. Residents’ access to ethics consultations: knowledge, use, and perceptions. Academic Medicine 2005; 80: 168-175.
18. Forde R, Vandvik IH. Clinical ethics, information, and communication: review of 31 cases from a clinical ethics committee. J Med Ethics 2006; 31: 73-77.
19. Orlowski JP, Hein S, Christensen JA, Meinke R, Sincich T. Why doctors use or do not use ethics consultation? J Med Ethics 2006; 32: 499-503.
20. Racine E, Hayes K. The need for a clinical ethics service and its goals in a community healthcare service centre: a survey. J Med Ethics 2006; 32: 564-566.
21. Hurst SA, Perrier A, Pegoraro R, Reiter-Th eil S, Forde R, Slowther AM et al. Ethical difficulties in clinical practice: experiences of European doctors. J Med Ethics 2007; 33: 51-57.
22. Karlıkaya E. Expectations and attitudes concerning ethics consultation of physicians’ goals in a community and nurses working in clinics. PhD dissertation, İstanbul University, Institute of Health Sciences; 2007 (in Turkish).
23. Chwang E, Landy D, Sharp R. Views regarding the training of ethics consultants: a survey of physicians caring for ICU patients. J Med Ethics 2007; 33: 320-324.
24. Nagao N, Aulisio MP, Nukaga Y, Fujita M, Kosugi S, Youngner S et al. Clinical ethics consultation: examining how American and Japanese experts analyze an Alzheimer’s case. BMC Medical Ethics 2008; 9: 2 (doi: 10.1186/1472-6939-9-2).