PDF(Pubmed)
Abstract：
BACKGROUND: At the beginning of the coronavirus (Covid-19) pandemic, many non-Covid healthcare services were suspended. In April 2020, the Department of Health in England mandated that non-Covid services should resume, alongside the continuing pandemic response. This \'resetting\' of healthcare services created a unique context in which it became critical to consider how ethical considerations did (and should) underpin decisions about integrating infection control measures into routine healthcare practices. We draw on data collected as part of the \'NHS Reset Ethics\' project, which explored the everyday ethical challenges of resetting England\'s NHS maternity and paediatrics services during the pandemic.
METHODS: Healthcare professionals and members of the public participated in interviews and focus group discussions. The qualitative methods are reported in detail elsewhere. The focus of this article is our use of Frith\'s symbiotic empirical ethics methodology to work from our empirical findings towards the normative suggestion that clinical ethics should explicitly attend to the importance of relationships in clinical practice. This methodology uses a five-step approach to refine and develop ethical theory based on a naturalist account of ethics that sees practice and theory as symbiotically related.
RESULTS: The Reset project data showed that changed working practices caused ethical challenges for healthcare professionals, and that infection prevention and control measures represented harmful barriers to the experience of receiving and offering care. For healthcare professionals, offering care as part of a relational interaction was an ethically important dimension of healthcare delivery.
CONCLUSIONS: Our findings suggest that foregrounding the importance of relationships across a hospital community will better promote the ethically important multi-directional expression of caring between healthcare professionals, patients, and their families. We offer two suggestions for making progress towards such a relational approach. First, that there is a change of emphasis in clinical ethics practice to explicitly acknowledge the importance of the relationships (including with their healthcare team) within which the patient is held. Second, that organisational decision-making should take into account the moral significance afforded to caring relationships by healthcare professionals, and the role such relationships can play in the negotiation of ethical challenges.
METHODS: Healthcare professionals and members of the public participated in interviews and focus group discussions. The qualitative methods are reported in detail elsewhere. The focus of this article is our use of Frith\'s symbiotic empirical ethics methodology to work from our empirical findings towards the normative suggestion that clinical ethics should explicitly attend to the importance of relationships in clinical practice. This methodology uses a five-step approach to refine and develop ethical theory based on a naturalist account of ethics that sees practice and theory as symbiotically related.
RESULTS: The Reset project data showed that changed working practices caused ethical challenges for healthcare professionals, and that infection prevention and control measures represented harmful barriers to the experience of receiving and offering care. For healthcare professionals, offering care as part of a relational interaction was an ethically important dimension of healthcare delivery.
CONCLUSIONS: Our findings suggest that foregrounding the importance of relationships across a hospital community will better promote the ethically important multi-directional expression of caring between healthcare professionals, patients, and their families. We offer two suggestions for making progress towards such a relational approach. First, that there is a change of emphasis in clinical ethics practice to explicitly acknowledge the importance of the relationships (including with their healthcare team) within which the patient is held. Second, that organisational decision-making should take into account the moral significance afforded to caring relationships by healthcare professionals, and the role such relationships can play in the negotiation of ethical challenges.
摘要：
背景：在冠状病毒(新冠肺炎)大流行开始时，许多非Covid医疗服务被暂停。2020年4月，英国卫生部要求恢复非新冠肺炎服务，以及持续的大流行应对措施。医疗保健服务的这种“重置”创造了一个独特的背景，在这种背景下，考虑道德考虑如何（并且应该）支持将感染控制措施纳入常规医疗保健实践的决策变得至关重要。我们利用“NHS重置道德”项目中收集的数据，它探讨了在大流行期间重置英格兰NHS产妇和儿科服务的日常道德挑战。
方法：医疗保健专业人员和公众参与了访谈和焦点小组讨论。定性方法在其他地方详细报道。本文的重点是我们使用Frith的共生经验伦理学方法，从我们的经验发现到规范建议，即临床伦理学应明确关注临床实践中关系的重要性。这种方法使用五步方法来完善和发展基于自然主义者对伦理学的解释的伦理学理论，该理论认为实践和理论是共生的。
结果：重置项目数据显示，改变的工作实践给医疗保健专业人员带来了道德挑战，感染预防和控制措施对接受和提供护理的经验构成了有害障碍。对于医疗保健专业人员，作为关系互动的一部分提供护理是医疗保健提供的伦理重要维度。
结论：我们的研究结果表明，将整个医院社区关系的重要性纳入前景将更好地促进医疗保健专业人员之间在伦理上重要的多方向表达关怀，病人,和他们的家人。我们为朝着这种关系方法取得进展提供了两个建议。首先,临床伦理实践的重点有所改变，以明确承认患者所在的关系（包括与他们的医疗团队）的重要性。第二,组织决策应考虑到医疗保健专业人员对关怀关系的道德意义，以及这种关系在道德挑战谈判中可以发挥的作用。
方法：医疗保健专业人员和公众参与了访谈和焦点小组讨论。定性方法在其他地方详细报道。本文的重点是我们使用Frith的共生经验伦理学方法，从我们的经验发现到规范建议，即临床伦理学应明确关注临床实践中关系的重要性。这种方法使用五步方法来完善和发展基于自然主义者对伦理学的解释的伦理学理论，该理论认为实践和理论是共生的。
结果：重置项目数据显示，改变的工作实践给医疗保健专业人员带来了道德挑战，感染预防和控制措施对接受和提供护理的经验构成了有害障碍。对于医疗保健专业人员，作为关系互动的一部分提供护理是医疗保健提供的伦理重要维度。
结论：我们的研究结果表明，将整个医院社区关系的重要性纳入前景将更好地促进医疗保健专业人员之间在伦理上重要的多方向表达关怀，病人,和他们的家人。我们为朝着这种关系方法取得进展提供了两个建议。首先,临床伦理实践的重点有所改变，以明确承认患者所在的关系（包括与他们的医疗团队）的重要性。第二,组织决策应考虑到医疗保健专业人员对关怀关系的道德意义，以及这种关系在道德挑战谈判中可以发挥的作用。
