Making difficult ethical decisions in patient care during natural disasters and other mass casualty events
Making difficult ethical decisions in patient care during natural disasters and other mass casualty events
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DOI：
10.1016/j.otohns.2008.04.027
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发表时间：
2008-08-01
影响因子：
3.4
通讯作者：
Holt, G. Richard
中科院分区：
文献类型：
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作者：
Holt, G. Richard
目标：美国最近发生的史无前例的恐怖袭击（9/11）和毁灭性的自然灾害（卡特里娜飓风）表明，在此类灾难中对大规模伤亡人员的医疗护理提出了平民医疗保健中通常不会遇到的道德问题。重要的是：1）确定有义务照顾此类灾难受害者的医生所面临的独特伦理挑战，2）制定全国伦理指南共识，作为医疗救灾伦理决策的资源。研究设计：对相关文献进行了调查，以评估有关恐怖袭击和自然灾害中的医疗护理条件、灾难医疗护理的伦理挑战以及灾难中的专业责任和响应能力的经验和意见。结论：有必要制定一个全国性的伦理指南。就护理灾难患者、受害者和伤员的医生的道德准则达成共识，并在这种极端条件下制定基于美德且实用的道德医疗方法。需要为医学生、住院医生和执业医生提供教育课程，以便为未来可能需要对患者进行分类、分配资源以及就治疗优先事项和舒适护理做出艰难决定的所有医生做好充分准备。这些问题不宜在灾难发生时解决，而应提前解决，作为医学职业道德教育的一部分。需要解决的重要问题包括住院病人和伤员的分类和优先顺序、医疗责任、护理标准的改变、正义和公平、知情同意和病人自主权、扩大灾难医学的实践范围，以及医生照顾灾难受害者的道德和伦理责任。 (C) 2008 年美国耳鼻喉科学会-头颈外科基金会。版权所有。
OBJECTIVE: Recent experiences in the United States with unprecedented terrorist attacks (9/11) and a devastating natural disaster (Hurricane Katrina) have demonstrated that the medical care of mass casualties during such disasters poses ethical problems not normally experienced in civilian health care. It is important to 1) identify the unique ethical challenges facing physicians who feel an obligation to care for victims of such disasters and 2) develop a national consensus on ethical guidelines as a resource for ethical decision making in medical disaster relief.STUDY DESIGN: A survey of pertinent literature was performed to assess experience and opinions on the condition of medical care in terrorist attacks and natural disasters, the ethical challenges of disaster medical care, and the professional responsibilities and responsiveness in disasters.CONCLUSIONS: It is necessary to develop a national consensus on the ethical guidelines for physicians who care for patients, victims, and casualties of disasters, and to formulate a virtue-based, yet practical, ethical approach to medical care under such extreme conditions. An educational curriculum for medical students, residents, and practicing physicians is required to best prepare all physicians who might be called upon, in the future, to triage patients, allocate resources, and make difficult decisions about treatment priorities and comfort care. It is not appropriate to address these questions at the time of the disaster, but rather in advance, as part of the ethics education of the medical profession. Important issues for resolution include inpatient and casualty triage and prioritization, medical liability, altered standards of care, justice and equity, informed consent and patient autonomy, expanding scope of practice in disaster medicine, and the moral and ethical responsibilities of physicians to care for disaster victims. (C) 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.