The choices we make: Ethical challenges in trauma surgery.

Autor: Chotai PN; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN; Division of Transplantation, Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH; Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN. Electronic address: https://twitter.com/txpchotai., Kuzemchak MD; Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN., Patel MB; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN; Surgical Services, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN; Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt Center for Health Services Research, Nashville, TN., Hammack-Aviran C; Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN., Dennis BM; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN., Gondek SP; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN., Guillamondegui OD; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN., Meador KG; Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN; Department of Psychiatry and Behavior Sciences, Vanderbilt University Medical Center, Nashville, TN; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN; Ethics and Society, Vanderbilt Divinity School, Nashville, TN., Wallston KA; Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN., Chen H; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN., Peetz AB; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN; Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN; Surgical Services, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN. Electronic address: allan.b.peetz@vumc.org.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2022 Jul; Vol. 172 (1), pp. 453-459. Date of Electronic Publication: 2022 Feb 28.
DOI: 10.1016/j.surg.2022.01.040
Abstrakt: Background: Ethical issues in trauma surgery are commonplace but scarcely studied. We aim to characterize the ethical dilemmas trauma surgeons encounter in clinical practice and describe perceptions about the ability to manage these dilemmas and strategies they use to address them.
Methods: Members of a U.S. trauma society were electronically surveyed on handling ethically challenging scenarios. The survey instrument was developed using published ethics literature and iterative cognitive interviews. Domains included perceived frequency of encountering and self-efficacy of managing ethical situations in trauma surgery. Common situations were defined as those encountered monthly or weekly. Ethical problems were categorized within 7 larger categories: general ethics, autonomy, communication, justice, end-of-life, conflict, and other. Descriptive analyses were performed; group comparisons were analyzed using analysis of variance.
Results: Of 1,748 surveyed, 548 responded (30.6%) and 154 (28%) were female. Most were White, under 55 years age, had completed fellowship training, and were practicing at a level I or II trauma center. The most encountered ethical categories were generic ethics and communication (79%). Issues involving conflict were least frequent (21%). Respondents felt most uncomfortable with autonomy topics. Respondents with high self-efficacy in handling ethical situations were older, in practice ≥15 years, served on an ethics committee, and/or frequently experienced ethical challenges.
Conclusion: Most trauma surgeons regularly encounter ethical challenges, especially those related to communication. Trauma surgeons encounter ethical issues involving conflict least often, and lowest self-efficacy scores with issues involving autonomy. Experienced trauma surgeons reported higher self-efficacy scores in managing ethical issues. Future work should examine how self-efficacy translates to observed behavior, and how trauma surgeons build and enhance their ethical skillsets in the care of the injured patient.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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