Evaluation of pediatric residents’ attitudes toward ethical conflict: a cross-sectional study in Tehran, Iran
AbstractEthical conflicts are recognized as critical aspects in assessing competence in clinical communication. Moreover, pediatrics residents may face more problems, compared to other disciplines; due to the specific characteristics of the age group receiving services as well as the presence of their families. This study has been conducted with the aim of determining the attitude and perspective of pediatric residents toward ethical conflicts in the field of pediatrics. This descriptive, cross-sectional study was carried out on all residents of Tehran University of Medical Sciences (90 residents), selected through census method, in 2014. The data collection tool was a 32-item research-based questionnaire. Its validity and reliability were confirmed by the researchers and the medical faculty members. To analyze data, descriptive and inferential statistics were used. However, based on the results, lack of an advanced directive and written procedure for withdrawing life-sustaining treatment of an incompetent or critically-ill child (4.38 ± 0.80), lack of provision of sufficient information on obtaining informed consent (4.12 ± 1.10), and the absence of a legal written process for doing not resuscitate (DNR) orders (3.98 ± 0.95) were the most salient causes of ethical conflicts in pediatrics. Furthermore, in accordance with the linear regression analysis of demographic characteristics, there was a significant relationship (P = 0.04, r = 0.046) between residents’ year of education and attitude toward ethical conflict; however, this relationship was not observed in other demographic characteristics. Taking the priorities of ethical conflicts in pediatrics into account may help improve the designing of medical ethics education programs in hospitals for residents, thereby reducing the conflicts related to the issues of medical ethics.
2. Ayatollahi Z. A logical study on ethical dilemmas. Logical Study 2013; 3(2): 1-20. [in Persian].
3. Cook AF, Sobotka SA, Ross LF. Teaching and assessment of ethics and professionalism: a survey of pediatric program directors. Acad Pediatr. 2013; 13(6): 570-6.
4. Breuner CC, Moreno MA. Approaches to the difficult patient/parent encounter. Pediatrics. 2011; 127(1): 163-9.
5. Boss RD, Geller G, Donohue PK. Conflicts in learning to care for critically ill newborns: "It makes me question my own morals". J Bioeth Inq. 2015; 12(3): 437-48.
6. Pye K. Exploring moral distress in pediatric oncology; a sample of registered practitioners. Issues Compr Pediatr Nurs. 2013; 36(4): 248-61.
7. Mohebbi Amin S, Rabiei M, Keizoori AH. A review of students’ evaluation of the medical ethics curriculum. Iran J Med Ethics Hist Med. 2015; 8(3): 77-86. [in Persian]
8. Khajedaluee M, Movafaghi Z, Pouryazdanpanah M. Effectiveness of the medical ethics curriculum: viewpoints of interns in Mashhad University of Medical sciences. Iran J Med Ethics Hist Med. 2013; 6(5): 67-76. [In Persian]
9. Mobasher M, Aramesh K, Zahedi F, Nakhaee N, Tahmasebi M, Larijani B. End-of-life care ethical decision-making: Shiite scholars' views. J Med Ethics Hist Med. 2014; 7:2.
10. Hilliard RI, Fernandez CV, Tsai E. Ethical participation of children and youth in medical education. Paediatr Child Health. 2011; 16(4): 223–27.
11. Cheraghi M, Bahramnezhad F, Mehrdad N. Experiences of Iranian physicians regarding do not resuscitate: a directed content analysis. J Med Ethics Hist Med. 2016; 9: 9.
12. Beigy M, Pishgahi G, Moghaddas F, et al. Students' medical ethics rounds: a combinatorial program for medical ethics education. J Med Ethics Hist Med. 2016; 9:3.
13. Bagheri A. Iranian medical ethics priorities: the results of a national study. Iran J Med Ethics Hist Med. 2010; 4(5): 39-48. [in Persian].
14. de Vos MA, Bos AP, Plötz FB, et al. Talking with parents about end-of-life decisions for their children. Pediatrics. 2015; 135(2): e465-76.
15. Carnevale FA, Farrell C, Cremer R, et al. Struggling to do what is right for the child: pediatric life-support decisions among physicians and nurses in France and Quebec. J Child Health Care. 2012; 16(2): 109-23.
16. de Vos MA, van der Heide A, Maurice-Stam H, et al. The process of end-of-life decision-making in pediatrics: a national survey in the Netherlands. Pediatrics. 2011; 127(4): e1004-12.
17. Bateman ST, Dixon R, Trozzi M. The wrap-up: a unique forum to support pediatric residents when faced with the death of a child. J Palliat Med. 2012; 15(12): 1329-34.
18. Townsend SF. Ethics for the pediatrician: obstetric conflict: when fetal and maternal interests are at odds. Pediatr Rev. 2012; 33(1): 33-7.
19. Hein IM, Troost PW, Broersma A, de Vries MC, Daams JG, Lindauer RJ. Why is it hard to make progress in assessing children's decision-making competence? BMC Med Ethics. 2015; 16: 1.
20. Schwartz JA. Innovation in pediatric surgery: the surgical innovation continuum and the ETHICAL model. J Pediatr Surg. 2014; 49(4): 639-45.
21. Howard F, McKneally MF, Upshur RE, Levin AV. The formal and informal surgical ethics curriculum: views of resident and staff surgeons in Toronto. Am J Surg. 2012; 203(2): 258-65.
22. Rivera-Spoljaric K, Halley M, Wilson SR. Shared clinician-patient decision-making about treatment of pediatric asthma: what do we know and how can we use it? Curr Opin Allergy Clin Immunol. 2014; 14(2): 161-7.
23. Brisson GE, Neely KJ, Tyler PD, Barnard C. Should medical students track former patients in the electronic health record? An emerging ethical conflict. Acad Med. 2015; 90(8): 1020-4.
24. Stockley AJ, Forbes K. Medical professionalism in the formal curriculum: 5th year medical students’ experiences. BMC Med Educ. 2014; 14: 259.
25. Keshmiri F, Sohrabpour A, Farahmand S, et al. Inter-professional ethics education in team-based approach: values and ethics development in inter-professional collaboration. Iran J Med Ethics Hist Med. 2013; 6(4): 42-56. [in Persian]
26. Stenmarker M, Hallberg U, Palmérus K, Márky I. Being a messenger of life-threatening conditions: experiences of pediatric oncologists. Pediatr Blood Cancer. 2010; 55(3): 478-84.
27. Tataw DB. Provider perceptions of the social work environment and the state of pediatric care in a downsized urban public academic medical center. J Evid Based Soc Work. 2011; 8(3): 275-93.
28. Van McCrary S, Green HC, Combs A, Mintzer JP, Quirk JG. A delicate subject: the impact of cultural factors on neonatal and perinatal decision making. J Neonatal Perinatal Med. 2014; 7(1): 1-12.