Typologie et fonctionnement des espaces de discussion éthique en France dans le domaine de la Santé

Introduction : L’éthique médicale pose la question du sens des pratiques médicales à la lumière des sciences humaines. En France, les espaces de discussion éthique (EDE) sont multiples et hétérogènes. L’objectif de ce travail était d’étudier la typologie et le fonctionnement des EDE dans le domaine de la santé. Méthodes : Vingt-et-un entretiens semi-dirigés ont été menés auprès de membres de onze EDE différents en France. Les données ont été analysées selon les étapes de base d’une recherche qualitative : codage, catégorisation, mise en relation et présentation des résultats. Résultats : Les cinq catégories d’EDE (Comité consultatif national d’éthique, Espaces de réflexion éthique régionaux, Commission éthique des sociétés savantes médicales, Comités éthiques d’institut de recherche, Comités éthiques hospitaliers) diffèrent toutes de par leurs liens avec les institutions, leurs compositions, leurs choix de thèmes discutés et la restitution de leur travail. Cependant, toutes concordent sur les points suivants : l’importance de la pluridisciplinarité, la fréquence des réunions de travail, le sens de l’engagement éthique, l’absence de reconnaissance professionnelle, la difficile valorisation des travaux et le manque de reconnaissance par les pairs. Les répondants regrettent une insuffisante articulation entre les différents EDE, bien que leurs travaux puissent être complémentaires. Conclusion : Décloisonner les EDE et favoriser leur articulation, sans les éloigner de la pratique de soin, pourrait favoriser la visibilité de leur démarche éthique dans le quotidien des soignants. Enfin, si la réflexion éthique est encouragée par l’ensemble de la communauté scientifique, une plus grande valorisation est souhaitée par les professionnels qui participent à des recherches en éthique appliquée

Hospitais em crise : uma etnografia dos cirurgiões gerais em Portugal

Doutoramento em Sociologia Económica e das OrganizaçõesEsta investigação tem como objetivo a reflexão sobre o impacto de fatores externos como as restrições de ordem orçamental (inicialmente impostas pelo Programa de Ajustamento da Troika e que se mantêm na atualidade) e o aparecimento do vírus SARS-CoV-2 (que representa a maior e mais lenta crise mundial de saúde pública do século XXI) na atividade dos cirurgiões gerais em Portugal. Importa determinar as suas consequências na organização Hospital e na ordem aí estabelecida, nas tarefas médicas, bem como no engrossar das listas de espera e no agravamento da doença cirúrgica. Através da utilização de uma abordagem mista, que combina fontes de dados qualitativas (como entrevistas semiestruturadas aos atores e principais stakeholders, ações de shadowing, observação participante e não participante e análise documental) e quantitativas (inquérito aos cirurgiões gerais), o estudo procura aferir os reais efeitos na atividade cirúrgica dos setores público e privado em diferentes cenários, como a ausência de recursos materiais, humanos e de equipamentos de proteção individual, essenciais ao lidar com a pandemia COVID-19. Identificamos momentos críticos e hostis ao desempenho da expertise destes especialistas (alcançada através de uma profissionalização prolongada no tempo e em constante revisão), potenciados por barreiras de ordem económica e de saúde pública e apuramos existirem limitações na ação e na tomada de decisão dos cirurgiões sobre o melhor tratamento para os seus doentes.This investigation aims to reflect on the impact of external factors such as budgetary restrictions (initially imposed by the Troika Adjustment Program and which are currently maintained) and the emergence of the SARS-CoV-2 virus (which represents the largest and slower global public health crisis of the 21st century) interfered in the activity of general surgeons in Portugal. It is important to determine its consequences on the organization named Hospital and its established order, in the medical tasks, as well as on the increase in waiting lists and the worsening of the surgical disease. Through the use of a mixed approach, which combines qualitative data sources (such as semi-structured interviews with actors and main stakeholders, shadowing actions, participant and non-participant observation and document analysis) and quantitative (a survey for general surgeons), the study seeks to assess the real effects on surgical activity in the public and private sectors in different scenarios, such as the absence of material, human resources and essential personal protective equipments when dealing with the COVID-19 pandemic. We have identified critical and hostile moments to the performance of the expertise of this specialists (achieved through a prolonged professionalization in time and constant review), boosted by economic and public health barriers and found out limitations in the action and decision-making of surgeons concerning the best treatment for their patients.info:eu-repo/semantics/publishedVersio

Hospital ethics committees in accredited hospitals in Poland - availability of information

The role of Hospital Ethics Committees (HECs) is to support patients and their relatives as well as medical staff in solving ethical issues that arise in relation to the implementation of medical care. In Poland there are no clearly formulated legal regulations concerning the establishment and functioning of hospital ethics committees. Hospitals applying for accreditation are obliged to present solutions defining the way of solving ethical issues in a given institution, some of them appoint HECs for this purpose. The aim of this study was to analyze information concerning the functioning of hospital ethics committees in Poland on the basis of publicly available data published on the websites of accredited hospitals. Very few accredited hospitals (56) make public information about functioning in their ethics consulting facilities through hospital ethics committees. In most cases, the information provided on the functioning of HECs is general, both in terms of the committees’ functioning, type of cases under consideration and the composition of personnel

Activities of hospital ethics committees : availability of information on hospital websites

Szpitalne komisje etyczne (SKE) funkcjonują w systemach opieki zdrowotnej od wielu lat. Ich głównym zadaniem jest pomoc zarówno pacjentom i ich bliskim, jak i personelowi medycznemu w rozwiązywaniu problemów natury etycznej pojawiających się w związku z realizowaniem opieki medycznej. Celem pracy była ocena zakresu informacji dotyczących funkcjonowania szpitalnych komisji etycznych w Polsce, udostępnianych na stronach internetowych szpitali. Analizie poddano strony internetowe szpitali akredytowanych oraz placówek ujętych w wykazie prowadzonym przez Ośrodek Bioetyki Naczelnej Izby Lekarskiej. W wyniku przeprowadzonej analizy stwierdzono, że niemal połowa badanych placówek (50,7%) nie przedstawia składu osobowego powołanych komisji. Tylko w przypadku jednej komisji wskazano, że jej członkowie mają wykształcenie w zakresie bioetyki. Zadaniem większości SKE (72,5%) jest ochrona praw pacjenta, rozwiązywanie problemów natury etycznej (66,7%), nadzór nad przestrzeganiem przez personel medyczny zasad etyki zawodowej (46,4%).Hospital ethics committees (HECs) have functioned in healthcare systems for many years. Their main task is to help patients and their relatives as well as medical staff in solving ethical problems that arise in connection with the implementation of medical care. The aim of the study was to find out what information on the functioning of hospital ethics committees in Poland is made available to interested persons on hospital websites. The websites of accredited hospitals and the establishments included in the list kept by the Center of Bioethics of the Supreme Medical Chamber were analyzed. Almost half of the surveyed institutions (50,7%) do not disclose the composition of the appointed committees. Only one committee indicated that its members had education in the field of bioethics. The task of most HECs (72,5%) is to protect a patient’s rights, solve ethical problems (66,7%), andto supervise the observance of professional ethics by medical personnel (46,4%)