■当个人感到无力去做他们认为正确的事情时,就会发生道德困扰,包括当临床医生被阻止提供他们认为必要的医疗保健时。多布斯诉杰克逊妇女卫生组织最高法院判决后,联邦对堕胎的保护丧失,可能会使提供堕胎的临床医生面临道德困扰的风险,因为许多人可能因提供符合专业标准的护理而面临新的法律和民事处罚,他们认为这是必要的。
■根据Dobbs的总体决定和州级堕胎政策,评估提供堕胎的临床医生的自我报告的道德困扰得分。
■这项调查研究,从2023年5月至12月进行,包括美国提供堕胎的临床医生(医生,先进的实践临床医生,和护士)。通过专业列表和滚雪球抽样,在全国范围内传播了有目的的电子调查。
■每个受访者的实践状态中的堕胎政策(限制性与保护性使用Guttmacher研究所的分类)。
■使用描述性统计数据以及未调整和调整的负二项回归模型,道德困扰温度计(MDT)上自我报告的道德困扰之间的关联,一个经过验证的心理测量工具,将道德困扰从0(无)评分到10(最坏的可能),并审查了国家堕胎政策。
■总的来说,310名临床医生(271[87.7%]名女性;平均[SD]年龄,41.4[9.7]年)完成352个MDT,206例(58.5%)来自保护状态,146例(41.5%)来自限制性状态。报告的道德困扰得分从0到10不等(中位数,5),与保护状态相比,限制性临床医生的数量增加了一倍以上(中位数,8[IQR,6-9]vs3[IQR,1-6];P<.001)。与高级执业临床医生相比,道德困扰得分较高的受访者包括医生(中位数,6[IQR,3-8]vs4[IQR,2-7];P=.005),在独立堕胎诊所执业的人与在医院执业的人(中位数,6[IQR,3-8]vs4[IQR,2-7];P<.001),不再提供堕胎护理的人与仍提供堕胎护理的人相比(中位数,8[IQR,4-9]vs5[IQR,2-8];P=.004),与处于稳定状态(未调整的发病率[IRR],1.72[95%CI,1.55-1.92];P<.001;调整后内部收益率,1.59[95%CI,1.40-1.79];P<.001),以及那些在激增状态(自多布斯决定以来流产量增加最大的状态)与稳定状态(未调整的IRR,1.27[95%CI,1.11-1.46];P<.001;调整后内部收益率,1.24[95%CI,1.09-1.41];P=.001)。
■在这项针对提供堕胎的临床医生的全国性调查研究中,在所有临床医生中,道德上的痛苦都有所增加,在限制堕胎的州中,与保护堕胎的州相比,道德上的痛苦是前者的两倍多。研究结果表明,结构性变化解决了对必要医疗保健的禁令,比如联邦对堕胎的保护,是机构需要的,state,和联邦政策层面打击广泛的道德困境。
UNASSIGNED: Moral distress occurs when individuals feel powerless to do what they think is right, including when clinicians are prevented from providing health care they deem necessary. The loss of federal protections for abortion following the Dobbs v Jackson Women\'s Health Organization Supreme Court decision may place clinicians providing abortion at risk of experiencing moral distress, as many could face new legal and civil penalties for providing care in line with professional standards and that they perceive as necessary.
UNASSIGNED: To assess self-reported moral distress scores among abortion-providing clinicians following the Dobbs decision overall and by state-level abortion policy.
UNASSIGNED: This survey study, conducted from May to December 2023, included US abortion-providing clinicians (physicians, advanced practice clinicians, and nurses). A purposive electronic survey was disseminated nationally through professional listservs and snowball sampling.
UNASSIGNED: Abortion policy in each respondent\'s state of practice (restrictive vs protective using classifications from the Guttmacher Institute).
UNASSIGNED: Using descriptive statistics and unadjusted and adjusted negative binomial regression models, the association between self-reported moral distress on the Moral Distress Thermometer (MDT), a validated psychometric tool that scores moral distress from 0 (none) to 10 (worst possible), and state abortion policy was examined.
UNASSIGNED: Overall, 310 clinicians (271 [87.7%] women; mean [SD] age, 41.4 [9.7] years) completed 352 MDTs, with 206 responses (58.5%) from protective states and 146 (41.5%) from restrictive states. Reported moral distress scores ranged from 0 to 10 (median, 5) and were more than double for clinicians in restrictive compared with protective states (median, 8 [IQR, 6-9] vs 3 [IQR, 1-6]; P < .001). Respondents with higher moral distress scores included physicians compared with advanced practice clinicians (median, 6 [IQR, 3-8] vs 4 [IQR, 2-7]; P = .005), those practicing in free-standing abortion clinics compared with those practicing in hospitals (median, 6 [IQR, 3-8] vs 4 [IQR, 2-7]; P < .001), those no longer providing abortion care compared with those still providing abortion care (median, 8 [IQR, 4-9] vs 5 [IQR, 2-8]; P = .004), those practicing in loss states (states with the greatest decline in abortion volume since the Dobbs decision) compared with those in stable states (unadjusted incidence rate [IRR], 1.72 [95% CI, 1.55-1.92]; P < .001; adjusted IRR, 1.59 [95% CI, 1.40-1.79]; P < .001), and those practicing in surge states (states with the greatest increase in abortion volume since the Dobbs decision) compared with those in stable states (unadjusted IRR, 1.27 [95% CI, 1.11-1.46]; P < .001; adjusted IRR, 1.24 [95% CI, 1.09-1.41]; P = .001).
UNASSIGNED: In this purposive national survey study of clinicians providing abortion, moral distress was elevated among all clinicians and more than twice as high among those practicing in states that restrict abortion compared with those in states that protect abortion. The findings suggest that structural changes addressing bans on necessary health care, such as federal protections for abortion, are needed at institutional, state, and federal policy levels to combat widespread moral distress.