Fenton Kathleen N, Cardarelli Marcelo, Molloy Frank, Novick William M
William Novick Global Cardiac Alliance,Memphis,TN,USA.
Cardiol Young. 2019 Jan;29(1):36-39. doi: 10.1017/S1047951118001713. Epub 2018 Oct 18.
In countries with ample resources, no debate exists as to whether heart surgery should be provided. However, where funding is limited, what responsibility exists to care for children with congenital heart defects? If children have a "right" to surgical treatment, to whom is the "duty" to provide it assigned? These questions are subjected to ethical analysis.
Examination is initially based on the four principles of medical ethics: autonomy, beneficence, non-maleficence, and justice. Consideration of beneficence and justice is expanded using a consequentialist approach.
Social structures, including governments, exist to foster the common good. Society, whether by means of government funding or otherwise, has the responsibility, according to the means available, to assure health care for all based on the principles of beneficence, non-maleficence, and justice. In wealthy countries, adequate resources exist to fund appropriate treatment; hence it should be provided to all based on distributive justice. In resource-limited countries, however, decisions regarding provision of care for expensive or complex health problems must be made with consideration for broader effects on the general public. Preliminary data from cost-effectiveness analysis indicate that many surgical interventions, including cardiac surgery, may be resource-efficient. Given that information, utilitarian ethical analysis supports dedication of resources to congenital heart surgery in many low-income countries. In the poorest countries, where access to drinking water and basic nutrition is problematic, it will often be more appropriate to focus on these issues first.
Ethical analysis supports dedication of resources to congenital heart surgery in all but the poorest countries.
在资源充足的国家，对于是否应提供心脏手术不存在争议。然而，在资金有限的情况下，照顾先天性心脏病患儿的责任是什么？如果儿童有接受手术治疗的“权利”，那么提供这种治疗的“义务”应由谁承担？这些问题需要进行伦理分析。
最初的审查基于医学伦理的四项原则：自主性、有益性、无害性和公正性。使用结果论方法对有益性和公正性进行了扩展考量。
包括政府在内的社会结构的存在是为了促进共同利益。社会，无论是通过政府资助还是其他方式，都有责任根据现有手段，基于有益性、无害性和公正性原则确保全民医疗保健。在富裕国家，有足够的资源为适当的治疗提供资金；因此，应基于分配正义为所有人提供治疗。然而，在资源有限的国家，在决定是否为昂贵或复杂的健康问题提供治疗时，必须考虑对公众的更广泛影响。成本效益分析的初步数据表明，包括心脏手术在内的许多外科干预措施可能具有资源效率。鉴于此信息，功利主义伦理分析支持在许多低收入国家将资源用于先天性心脏病手术。在最贫穷的国家，获取饮用水和基本营养存在问题，通常首先关注这些问题更为合适。
伦理分析支持在除最贫穷国家之外的所有国家将资源用于先天性心脏病手术。
