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A multi-systemic ethical dilemma model in hemodialysis patients: a qualitative study
Huiqing Zhu1, Anjie Zhao2, Yixing Zhou3
1Medical Department, the Second QiLu Hospital of Shandong University, Jinan, China.
BMC Medical Ethics
|June 10, 2026
Summary
Hemodialysis patients face ethical dilemmas across multiple systemic levels, from policy to personal struggles. Understanding these interconnected challenges requires holistic, systemic solutions for improved patient care.
Area of Science:
- Medical Ethics
- Nephrology
- Qualitative Research
Background:
- Hemodialysis patients encounter ethical tensions between clinical needs, personal values, and systemic constraints.
- Existing research primarily focuses on clinician perspectives, neglecting patient experiences of ethical dilemmas.
- This study addresses the gap by exploring ethical dilemmas from the patient's viewpoint in hemodialysis.
Purpose of the Study:
- To identify and analyze ethical dilemmas experienced by hemodialysis patients.
- To construct a multi-level conceptual model of these ethical dilemmas.
- To understand how systemic interactions influence ethical challenges in hemodialysis.
Main Methods:
- Qualitative descriptive design utilizing semi-structured interviews.
- 35 hemodialysis patients were recruited from four traditional Chinese medicine hospitals.
- Inductive thematic analysis informed by Ecological Systems Theory.
Main Results:
- Ethical dilemmas were categorized into three themes with 12 subthemes and 19 subcategories.
- A multi-systemic ethical dilemma model was developed, spanning macro (policy, culture), mezzo (provider, family), and micro (individual) levels.
- Interactions between levels demonstrate how dilemmas can generate or exacerbate each other.
Conclusions:
- A patient-centered, multi-systemic ethical dilemma model for hemodialysis was introduced.
- Ethical challenges are embedded within the care ecosystem, necessitating systemic, not just individual, solutions.
- Findings advocate for holistic approaches in research, practice, and policy to create ethically supportive environments for hemodialysis patients.
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