Map of ethical conflicts within hospitals

Objective: To explore the most common conflicts routinely occurring between patients/families and physicians/nurses in order to identify the most important ethical dilemmas. Material and method: Three focus group interviews were conducted with the participation of 12 members of the nursing staff (supervisors), and eight physicians (heads of department) in a district hospital in the north-west of Murcia (Spain). At the end of each focus group interview, the participants completed a brief questionnaire with the aim of prioritizing conflicts. Results: The mean age was 41 +/- 6 years in participating nurses and 51 +/- 5 years in physicians. Forty-seven ethical conflicts were identified by physicians, and 59 by nurses. These conflicts were grouped into five risk areas: professional, clinical, social, organizational, and legal. Of the dilemmas identified, 14 in the physicians' group and 16 in the nurses' groups were major, notably those related to patient information, health and social resources, non-existence of internal norms regulating daily work, lack of knowledge of patient expectations, and current legislation. The most important problems faced by physicians and nurses were inappropriate use of scarce resources and inadequate patient information. Conclusions: This study identified the ethical conflicts between patients/families and health care professionals in a district hospital. Listing ethical conflicts provides ethics committees and hospital administrations with a useful framework for the management of these dilemmas.