Iserson Kenneth V
International Federation for Emergency Medicine and Department of Emergency Medicine, The University of Arizona, Tucson, Arizona.
J Emerg Med. 2018 Aug;55(2):288-293. doi: 10.1016/j.jemermed.2018.04.021.
Widespread epidemics, pandemics, and other risk-prone disasters occur with disturbing regularity. When such events occur, how should, and will, clinicians respond? The moral backbone of medical professionals-a duty to put the needs of patients first-may be sorely tested.
It is incumbent on health care professionals to ask what we must do and what we should do if a dangerous health care situation threatens both ourselves and our community. Despite numerous medical ethical codes, nothing-either morally or legally-requires a response to risk-prone situations from civilian clinicians; it remains a personal decision. The most important questions are: What will encourage us to respond to these situations? And will we respond? These questions are necessary, not only for physicians and other direct health care providers, but also for vital health care system support personnel. Those who provide care in the face of perceived risk demonstrate heroic bravery, but the choice to do so has varied throughout history. To improve individual response rates, disaster planners and managers must communicate the risks clearly to all members of the health care system and help mitigate their risks by providing them with as much support and security as possible.
The decision to remain in or to leave a risky health care situation will ultimately depend on the provider's own risk assessment and value system. If history is any guide, we can rest assured that most clinicians will choose to stay, following the heroic example established through the centuries and continuing today.
大规模流行病、大流行及其他易引发风险的灾难频繁发生,其规律令人不安。此类事件发生时,临床医生应如何应对,又会作何反应?医疗专业人员的道德支柱——将患者需求置于首位的职责——可能会受到严峻考验。
医疗保健专业人员有责任思考,如果危险的医疗保健情况同时威胁到自身和所在社区,我们必须做什么以及应该做什么。尽管有众多医学伦理准则,但在道德或法律层面,并无要求平民临床医生应对易引发风险的情况;这仍是个人决定。最重要的问题是:什么会促使我们应对这些情况?我们会做出回应吗?这些问题不仅对医生和其他直接的医疗保健提供者至关重要,对至关重要的医疗保健系统支持人员也同样重要。那些在面临可感知风险时仍提供护理的人展现出了英勇无畏,但这样做的选择在历史上却不尽相同。为提高个人的反应率,灾难规划者和管理者必须向医疗保健系统的所有成员清晰传达风险,并通过尽可能为他们提供支持和保障来帮助减轻他们的风险。
决定留在还是离开危险的医疗保健环境最终将取决于提供者自身的风险评估和价值体系。如果以历史为鉴,我们可以放心,大多数临床医生会选择留下来,追随几个世纪以来树立并延续至今的英勇典范。