Ethical reasoning in mixed nurse-physician groups.

Holm, Søren; Gjersøe, Peter; Grode, G; Hartling, O. J.; Ibsen, K E; Marcussen, Henrik Secher

doi:10.1136/jme.22.3.168

Cited by 23 publications

(23 citation statements)

References 2 publications

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“…These have included studies of doctors,12 – 15 the general public16 and, like this study, members from a variety of backgrounds who are involved in processes that make real resource allocation decisions 8 17 – 19. A consistent finding across these latter studies is the large number of reasons considered relevant by expert groups involving people from varying backgrounds.…”

Section: Discussionmentioning

confidence: 79%

What reasons do those with practical experience use in deciding on priorities for healthcare resources? A qualitative study

Hasman

McIntosh²,

Hope

2008

J Med Ethics

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Background: Priority setting is necessary in current healthcare services. Discussion of fair process has highlighted the value of developing reasons for allocation decisions on the basis of experience gained from real cases. Aim: To identify the reasons that those with experience of real decision-making concerning resource allocation think relevant in deciding on the priority of a new but expensive drug treatment. Methods: Semistructured interviews with members of committees with responsibility for making resource allocation decisions at a local level in the British National Health Service, analysed using modified grounded theory. Results: 22 interviews were carried out. 14 reasons were identified. Four reasons were almost universally considered most important: cost effectiveness; clinical effectiveness; equality and gross cost. No one reason was considered dominant. Some considerations, such as political directives and fear of litigation, were thought by many participants to distort decision-making. There was a substantial lack of agreement over the relevance of some reasons, such as the absence of alternative treatment for the condition. Conclusions: There is a clear consensus on the importance and role of a limited number of reasons in allocation decisions among participants. A focus on the process of decision-making, however, does not obviate the need for those involved in the process to engage with problematical ethical issues, nor for the importance of further ethical analysis.Over the past few decades, financial pressures have led governments and healthcare organisations to adopt systematic approaches to priority setting. Priority choices involve ethical values and a persisting challenge for policy-makers is to specify an appropriate package of health services that is ethically defensible.

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Section: Discussionmentioning

confidence: 79%

What reasons do those with practical experience use in deciding on priorities for healthcare resources? A qualitative study

Hasman

McIntosh²,

Hope

2008

J Med Ethics

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“…Although nurses spend significantly more time with the patients, their voice may not be heard. 19,20 Why does this occur? Is there not similar vocabulary or educational curriculum regarding ethics in health care?…”

Section: Discussionmentioning

confidence: 95%

Suffering and Ethical Caring: incompatible entities

Leners

Beardslee

1997

Nurs Ethics

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Ethical problems are continuing to expand in health care due to conflicts of technology and value. This study investigated what kind of ethical problems nurses face in clinical situations and what process they use in deciding on actions to take. Ethical theories in justice and caring were explored. Qualitative research was used and ethnographic analysis was conducted with six staff nurses from three clinical areas. An analysis of the data yielded an overarching theme of 'Suffering and ethical caring: incompatible entities'. Six domains were identified: informant definitions, preceding conditions, actions taken, intervening variables, risks and recommendations. Future research is needed in the field of client and family suffering and pain.

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“…In this research, both physicians and nurses of the related clinics or institute were included, to take into account the situational features, such as time constraints or interprofessional relations, that can influence the way in which ethical decision-making actually occurs 2. Nurses were included on the assumption that healthcare professionals other than physicians may perceive and solve ethical problems in clinical practice differently 16 17 27. The study was conducted from January to April 2007.…”

Section: Participants and Methodsmentioning

confidence: 99%