Bystander Ethics and Good Samaritanism: A Paradox for Learning Health Organizations
Bystander Ethics and Good Samaritanism: A Paradox for Learning Health Organizations
复制标题
DOI：
10.1002/hast.1031
复制
发表时间：
2019-07-01
影响因子：
3.3
通讯作者：
Platt, Richard
中科院分区：
文献类型：
--
作者：
Sabin, James E.;Cocoros, Noelle M.;Platt, Richard
2012年，美国医学研究所（U.S. Institute of Medicine）的一份报告呼吁对医疗保健采取不同的方式：“如果不改变，医疗保健将继续表现不佳；造成不必要的伤害；并使国家、州和家庭预算紧张。”他们建议，答案将是一个“持续学习”的卫生系统。伦理学家和研究人员敦促建立“学习型卫生组织”，整合来自患者护理数据的知识，不断提高护理质量。我们正在进行一项关于房颤的研究——一项被称为impact - afib的试验——的经验让我们对创建这些组织必须应对的挑战之一有了一些了解。尽管拟议的教育干预研究没有限制提供者和健康计划可以做什么，但监督小组认为，慈善的道德原则不允许研究人员在接受次优护理的对照组中充当“旁观者”。作为回应，研究人员设计了一个“变通方案”，使项目得以继续进行。我们认为，经验表明，我们所谓的“旁观者伦理”将给lho所设计的质量改进研究带来挑战。
In 2012, a U.S. Institute of Medicine report called for a different approach to health care: "Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets." The answer, they suggested, would be a "continuously learning" health system. Ethicists and researchers urged the creation of "learning health organizations" that would integrate knowledge from patient-care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation-a trial known as IMPACT-AFib-gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be "bystanders" in relation to a control group receiving suboptimal care. In response, the researchers designed a "workaround" that allowed the project to go forward. We believe the experience suggests that what we call "bystander ethics" will create challenges for the kinds of quality improvement research that LHOs are designed to do.