Hastings Cent Rep. 2020 May;50(3):79-80. doi: 10.1002/hast.1145.
The pandemic creates unprecedented challenges to society and to health care systems around the world. Like all crises, these provide a unique opportunity to rethink the fundamental limiting assumptions and institutional inertia of our established systems. These inertial assumptions have obscured deeply rooted problems in health care and deflected attempts to address them. As hospitals begin to welcome all patients back, they should resist the temptation to go back to business as usual. Instead, they should retain the more deliberative, explicit, and transparent ways of thinking that have informed the development of crisis standards of care. The key lesson to be learned from those exercises in rational deliberation is that justice must be the ethical foundation of all standards of care. Justice demands that hospitals take a safety-net approach to providing services that prioritizes the most vulnerable segments of society, continue to expand telemedicine in ways that improve access without exacerbating disparities, invest in community-based care, and fully staff hospitals and clinics on nights and weekends.
大流行给社会和世界各地的医疗保健系统带来了前所未有的挑战。与所有危机一样，这些挑战为重新思考我们既定体系的基本限制假设和体制惯性提供了独特的机会。这些惯性假设掩盖了医疗保健中根深蒂固的问题，并转移了人们解决这些问题的努力。随着医院开始欢迎所有患者回来，它们应该抵制恢复常态的诱惑。相反，它们应该保留更慎重、更明确和更透明的思维方式，这些方式为制定危机护理标准提供了信息。从这些理性思考的练习中吸取的关键教训是，正义必须成为所有护理标准的伦理基础。正义要求医院采取安全网方法提供服务，优先考虑社会中最脆弱的群体，继续以改善获取机会而不会加剧差距的方式扩大远程医疗，投资于基于社区的护理，并在夜间和周末为医院和诊所配备充足的人员。
