臨床助産師の経験する倫理的問題の特徴―東海4県の調査結果より

Nature of Typical Ethical Problems Encountered by Midwives in Perinatal Medical Care in the Tokai Area of Japan

本研究は、周産期医療に携わる助産師の倫理的問題を明らかにすることを目的に、助産師経験2年目以上の助産師814名に倫理的要素を含む14の場面を提示し、もっとも印象深い経験の事例の記述を求めた。収集された209事例を質的に分析し、倫理的問題と倫理的問題ではない問題の分類を行い、さらに倫理的問題の特徴を明らかにした。倫理的問題の分類結果は、命をどう捉えるかに関する問題が3割、医療者としての善行、患者の自律性に関する問題がそれぞれ約2割を占めていた。これらは、正常分娩において医師と同等の責任範囲のある助産師の専門性から、患者の意向を無視した医療、医師の都合による分娩方針、母子の命の優先という倫理的問題の特徴がみられた。

The aim of this study is to clarify the nature of typical ethical problems that midwives experience in providing perinatal medical care. We asked 115 hospitals to participate in this study, and 814 midwives from 65 of these hospitals served as study subjects. We conducted a questionnaire survey covering 1) demographic data, 2) frequency of encountering 14 ethical problem cases that are typical for midwives, and 3) free description of the most memorable among those 14 cases. A total of 209cases were collected and analyzed qualitatively. Every procedure was carried out with the approval of an institutional ethical review board.

Ethical problems were extracted from each case and categorized into eight ethical groups. Most cases involved life and death like abortion or treatment of helpless newborns in about 30% of the total, followed by the issues of physicians' beneficence and autonomy of patients in about 20% of them, respectively. On the other hand, there were cases with no ethical issue but rather medical problems like a difference between physicians and midwives in treatment policy. These results revealed a part of the nature of typical ethical problems experienced by midwives.