Department of Bioethics, Heart and Vascular Institute, Cleveland Clinic, Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Centre for Ethics in Medicine, University of Bristol, Bristol, UK.
Health Care Anal. 2019 Sep;27(3):185-201. doi: 10.1007/s10728-019-00376-8.
Austerity, by its very nature, imposes constraints by limiting the options for action available to us because certain courses of action are too costly or insufficiently cost effective. In the context of healthcare, the constraints imposed by austerity come in various forms; ranging from the availability of certain treatments being reduced or withdrawn completely, to reductions in staffing that mean healthcare professionals must ration the time they make available to each patient. As austerity has taken hold, across the United Kingdom and Europe, it is important to consider the wider effects of the constraints that it imposes in healthcare. Within this paper, we focus specifically on one theorised effect-moral distress. We differentiate between avoidable and unavoidable ethical challenges within healthcare and argue that austerity creates additional avoidable ethical problems that exacerbate clinicians' moral distress. We suggest that moral resilience is a suitable response to clinician moral distress caused by unavoidable ethical challenges but additional responses are required to address those that are created due to austerity. We encourage clinicians to engage in critical resilience and activism to address problems created by austerity and we highlight the responsibility of institutions to support healthcare professionals in such challenging times.
紧缩政策本质上通过限制我们可采取的行动方案来施加限制，因为某些行动方案代价过高或不够成本效益。在医疗保健领域，紧缩政策施加的限制有多种形式；从某些治疗方法的可获得性减少或完全取消，到人员配置减少，这意味着医疗保健专业人员必须为每个患者分配可用时间。随着紧缩政策在英国和欧洲的实施，重要的是要考虑它在医疗保健方面施加的限制的更广泛影响。在本文中，我们特别关注一个理论上的影响——道德困境。我们在医疗保健中区分可避免和不可避免的伦理挑战，并认为紧缩政策造成了额外的可避免的伦理问题，加剧了临床医生的道德困境。我们认为道德韧性是应对临床医生因不可避免的伦理挑战而产生的道德困境的合适反应，但需要采取额外的措施来解决因紧缩政策而产生的道德困境。我们鼓励临床医生参与批判性的韧性和行动主义，以解决因紧缩政策而产生的问题，并强调机构在这些具有挑战性的时期支持医疗保健专业人员的责任。
