University of Arizona, Department of Emergency Medicine, Tucson, Arizona.
West J Emerg Med. 2020 Apr 13;21(3):477-483. doi: 10.5811/westjem.2020.4.47549.
As clinicians and support personnel struggle with their responsibilities to treat during the current COVID-19 pandemic, several ethical issues have emerged. Will healthcare workers and support staff fulfill their duty to treat in the face of high risks? Will institutional and government leaders at all levels do the right things to help alleviate healthcare workers risks and fears? Will physicians be willing to make hard, resource-allocation decisions if they cannot first husband or improvise alternatives?With our healthcare facilities and governments unprepared for this inevitable disaster, front-line doctors, advanced providers, nurses, EMS, and support personnel struggle with acute shortages of equipment-both to treat patients and protect themselves. With their personal and possibly their family's lives and health at risk, they must weigh the option of continuing to work or retreat to safety. This decision, made daily, is based on professional and personal values, how they perceive existing risks-including available protective measures, and their perception of the level and transparency of information they receive. Often, while clinicians get this information, support personnel do not, leading to absenteeism and deteriorating healthcare services. Leadership can use good risk communication (complete, widely transmitted, and transparent) to align healthcare workers' risk perceptions with reality. They also can address the common problems healthcare workers must overcome to continue working (ie, risk mitigation techniques). Physicians, if they cannot sufficiently husband or improvise lifesaving resources, will have to face difficult triage decisions. Ideally, they will use a predetermined plan, probably based on the principles of Utilitarianism (maximizing the greatest good) and derived from professional and community input. Unfortunately, none of these plans is optimal.
在当前的 COVID-19 大流行期间，临床医生和支持人员在履行治疗职责时面临着几个道德问题。医护人员和支持人员是否会冒着高风险履行治疗义务？各级医疗机构和政府领导是否会采取正确的措施来帮助减轻医护人员的风险和恐惧？如果他们不能首先节约或临时替代资源，医生是否愿意做出艰难的资源分配决策？
由于我们的医疗设施和政府对这场不可避免的灾难毫无准备，一线医生、高级医护人员、护士、急救人员和支持人员都在努力应对设备严重短缺的问题，既要治疗患者，又要保护自己。由于个人甚至家人的生命和健康都面临风险，他们必须权衡继续工作或撤退到安全地带的选择。这个每天都要做出的决定是基于专业和个人价值观、他们对现有风险的看法（包括可用的保护措施）以及他们对所收到信息的水平和透明度的看法。通常，虽然临床医生能得到这些信息，但支持人员却得不到，这导致缺勤率上升，医疗服务质量下降。领导层可以通过良好的风险沟通（全面、广泛传播和透明）来调整医护人员的风险认知与现实相符。他们还可以解决医护人员必须克服的共同问题（即风险缓解技术）以继续工作。如果医生不能充分节约或临时替代救生资源，他们将不得不面对艰难的分诊决策。理想情况下，他们将使用预先确定的计划，该计划可能基于功利主义（最大限度地增加最大利益）原则，并从专业和社区的投入中得出。不幸的是，这些计划都不是最优的。
