Over the past year, our ethics service has had numerous consultations involving patients who use the emergency department for regular dialysis. Sometimes, they have access to outpatient hemodialysis that they forgo; other times, they've been "fired" from this kind of outpatient facility, and so the ED is their last option. In most of these cases, we're called because the patient is disruptive once admitted to the ICU and behavior plans haven't helped. But the call from a resident this March 2020 morning was different, the patient had end-stage renal disease and often missed hemodialysis, but he wasn't disruptive. "It's just that he comes in after using cocaine, and given scarcity with the coronavirus and ICU beds…." I have come to think that this is one of the more insidious effects of the pandemic: that there will be a resurgence of the view that some patients deserve health care by virtue of their compliant behavior and that those who are nonadherent don't.
在过去的一年里，我们的伦理服务部门接到了许多涉及到使用急诊室进行常规透析的患者的咨询。有时，他们可以选择门诊血液透析，但却放弃了；其他时候，他们被这种门诊机构“解雇”，因此急诊室是他们最后的选择。在大多数情况下，我们接到电话是因为患者一旦被收入 ICU 就会变得很具攻击性，而行为计划并没有起到帮助作用。但是，2020 年 3 月的一个早上，住院医生的电话却不同，这个患者患有终末期肾病，经常错过血液透析，但他并没有攻击性。“只是他在使用可卡因后才来，由于冠状病毒和 ICU 床位的稀缺性……”我开始认为这是大流行带来的更阴险的影响之一：一些患者由于顺从行为而理应得到医疗保健，而那些不遵守规定的患者则不应得到医疗保健。
