How organizational context affects bioethical decision-making: Pharmacists' management of gatekeeping processes in retail and hospital settings
How organizational context affects bioethical decision-making: Pharmacists' management of gatekeeping processes in retail and hospital settings
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DOI：
10.1016/j.socscimed.2012.11.041
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发表时间：
2013-12-01
影响因子：
5.4
通讯作者：
Chiarello, Elizabeth
中科院分区：
文献类型：
--
作者：
Chiarello, Elizabeth
生物伦理学的社会科学研究表明，伦理是高度情境化的，在不同的地方环境中，行为者在“实地”做出日常决定时，其作用是不同的。社会学研究表明，组织在塑造道德决策方面发挥的关键作用不成比例地集中在医院环境中工作的医生和护士，他们在那里与生死问题作斗争。本研究扩大了我们对伦理决策背景的理解，通过实证研究在零售和医院两个组织环境中工作的未充分研究的医疗保健专业人员药剂师，在那里他们作为监管商品和服务的守门人，因为他们与从严肃到世俗的伦理问题作斗争。本研究的问题是：组织如何塑造药剂师的识别、谈判和解决伦理挑战；换句话说，组织如何塑造药剂师的把关流程？基于2009年9月至2011年5月期间对在零售和医院药房执业的美国药剂师进行的95次半结构化访谈，本研究发现，组织通过塑造药剂师如何构建四个把关流程（医疗、法律、财政和道德）来影响道德决策。每个把关流程在不同的组织中表现不同，这是由于这些设置如何构建专业间的权力动态、与患者的接近程度以及获取信息的方式。研究结果表明，通过关注新的道德行为者、新的组织设置、扩大道德挑战的定义以及更广泛的把关概念，可以为医学背景下的道德决策理论化提供新的方向。(C) 2012 Elsevier Ltd.版权所有。
Social science studies of bioethics demonstrate that ethics are highly contextual, functioning differently across local settings as actors make daily decisions "on the ground." Sociological studies that demonstrate the key role organizations play in shaping ethical decision-making have disproportionately focused on physicians and nurses working in hospital settings where they contend with life and death issues. This study broadens our understanding of the contexts of ethical decision-making by empirically examining understudied healthcare professionals pharmacists working in two organizational settings, retail and hospital, where they act as gatekeepers to regulated goods and services as they contend with ethical issues ranging from the serious to the mundane. This study asks: How do organizations shape pharmacists' identification, negotiation, and resolution of ethical challenges; in other words, how do organizations shape pharmacists' gatekeeping processes? Based on 95 semi-structured interviews with U.S. pharmacists practicing in retail and hospital pharmacies conducted between September 2009 and May 2011, this research finds that organizations influence ethical decision-making by shaping how pharmacists construct four gatekeeping processes: medical, legal, fiscal, and moral. Each gatekeeping process manifests differently across organizations due to how these settings structure inter-professional power dynamics, proximity to patients, and means of accessing information. Findings suggest new directions for theorizing about ethical decision-making in medical contexts by drawing attention to new ethical actors, new organizational settings, an expanded definition of ethical challenges, and a broader conceptualization of gatekeeping. (C) 2012 Elsevier Ltd. All rights reserved.