The first nationwide study on facing and solving ethical dilemmas among healthcare professionals in Slovenia

Štefan Grosek; Rok Kučan; Jon Grošelj; Miha Oražem; Urh Grošelj; Vanja Erčulj; Jaro Lajovic; Ana Borovečki; Blaž Ivanc

doi:10.1371/journal.pone.0235509

The first nationwide study on facing and solving ethical dilemmas among healthcare professionals in Slovenia

PLoS One. 2020 Jul 14;15(7):e0235509. doi: 10.1371/journal.pone.0235509. eCollection 2020.

Authors

Štefan Grosek^{1

2

3}, Rok Kučan⁴, Jon Grošelj⁵, Miha Oražem⁶, Urh Grošelj⁷, Vanja Erčulj^{8

9}, Jaro Lajovic⁸, Ana Borovečki¹⁰, Blaž Ivanc¹¹

Affiliations

¹ Division of Surgery, Department of Paediatric Surgery and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia.
² Chair of Paediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
³ Neonatology Section, Division of Obstetrics and Gynaecology, Department of Perinatology, University Medical Centre, Ljubljana, Slovenia.
⁴ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
⁵ Theological Faculty, University of Ljubljana, Ljubljana, Slovenia.
⁶ Department of Radiation Oncology, Ljubljana Institute of Oncology, Ljubljana, Slovenia.
⁷ Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, UMC Ljubljana, Ljubljana, Slovenia.
⁸ Rho Sigma Research & Statistics, Ljubljana, Slovenia.
⁹ Faculty of Criminal Justice and Security, University of Maribor, Slovenia.
¹⁰ Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia.
¹¹ Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia.

Abstract

Background: Healthcare professionals (HCPs), patients and families are often faced with ethical dilemmas. The role of healthcare ethics committees (HECs) is to offer support in these situations.

Aim: The primary objective was to study how often HCPs encounter ethical dilemmas. The secondary objective was to identify the main types of ethical dilemmas encountered and how HCPs solve them.

Subjects and methods: We conducted a cross-sectional, survey-based study among HCPs in 14 Slovenian hospitals. A questionnaire was designed and validated by HCPs who were selected by proportional stratified sampling. Data collection took place between April 2015 and April 2016.

Results: The final sample size was n = 485 (385 or 79.4%, female). The response rates for HCPs working in secondary and tertiary level institutions were 45% and 51%, respectively. Three hundred and forty (70.4%) of 485 HCPs (very) frequently encountered ethical dilemmas. Frequent ethical dilemmas were waiting periods for diagnostics or treatment, suboptimal working conditions due to poor interpersonal relations on the ward, preserving patients' dignity, and relations between HCPs and patients. Physicians and nurses working in secondary level institutions, compared to their colleagues working in tertiary level institutions, more frequently encountered ethical dilemmas with respect to preserving patients' dignity, protecting patients' information, and relations between HCPs and patients. In terms of solutions, all HCPs most frequently discussed ethical dilemmas with co-workers (colleagues), and with the head of the department. According to HCPs, the most important role of HECs is staff education, followed by improving communication, and reviewing difficult ethical cases.

Conclusions: Waiting periods for diagnostics and treatment and suboptimal working conditions due to poor interpersonal relations are considered to be among the most important ethical issues by HCPs in Slovenian hospitals. The most important role of HECs is staff education, improving communication, and reviewing difficult ethical cases.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cross-Sectional Studies
Female
Health Personnel / ethics*
Hospitals / statistics & numerical data
Humans
Male
Slovenia
Surveys and Questionnaires*

Grants and funding

The study was funded as part of the research program Terciar—Project development of the Committee for Medical Ethics University Medical Centre Ljubljana and Clinical Ethics (No: 20140215) of the University Medical Centre Ljubljana in the years 2014–2016. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.