Centre for Ethics in Medicine, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
BMC Med Ethics. 2020 Jul 15;21(1):60. doi: 10.1186/s12910-020-00491-5.
As the COVID-19 (coronavirus) pandemic develops, healthcare professionals are looking for support with, and guidance to inform, the difficult decisions they face. In the (current) absence of an authoritative national steer in England, professional bodies and local organisations have been developing and disseminating their own ethical guidance. Questions inevitably arise, some of which are particularly pressing during the pandemic, as events are unfolding quickly and the field is becoming crowded. My central question here is: which professional ethical guidance should the professional follow?
Adopting a working definition of "professional ethical guidance", I offer three domains for a healthcare professional to consider, and some associated questions to ask, when determining whether - in relation to any guidance document - they should "bin it or pin it". First, the professional should consider the source of the guidance: is the issuing body authoritative or, if not, at least sufficiently influential that its guidance should be followed? Second, the professional should consider the applicability of the guidance, ascertaining whether the guidance is available and, if so, whether it is pertinent. Pertinence has various dimensions, including whether the guidance applies to this professional, this patient and/or this setting, whether it is up-to-date, and whether the guidance addresses the situation the professional is facing. Third, the professional should consider the methodology and methods by which the guidance was produced. Although the substantive quality of the guidance is important, so too are the methods by which it was produced. Here, the professional should ask whether the guidance is sufficiently inclusive - in terms of who has prepared it and who contributed to its development - and whether it was rigorously developed, and thus utilised appropriate processes, principles and evidence.
Asking and answering such questions may be challenging, particularly during a pandemic. Furthermore, guidance will not do all the work: professionals will still need to exercise their judgment in deciding what is best in the individual case, whether or not this concerns COVID-19. But such judgments can and should be informed (and constrained) by guidance, and hopefully these preliminary observations will provide some useful pointers for time-pressed professionals.
随着 COVID-19（冠状病毒）疫情的发展，医疗保健专业人员正在寻求支持，并寻求指导，以应对他们所面临的困难决策。在英国目前缺乏权威的国家指导的情况下，专业机构和地方组织一直在制定和传播自己的道德准则。不可避免地会出现一些问题，其中一些在疫情期间尤为紧迫，因为事件迅速发展，领域变得拥挤。我在这里的核心问题是：专业人员应该遵循哪种专业道德准则？
采用“专业道德准则”的工作定义，我为医疗保健专业人员提供了三个领域的考虑，并提出了一些相关问题，以确定他们是否应该“扔掉它还是保留它”，从而确定是否与任何指导文件相关。首先，专业人员应考虑指导的来源：发布机构是否具有权威性，或者，如果没有权威性，至少是否具有足够的影响力，使其指导应该得到遵循？其次，专业人员应考虑指导的适用性，确定指导是否可用，如果可用，是否相关。相关性有多个维度，包括指导是否适用于该专业人员、该患者和/或该环境，是否是最新的，以及指导是否解决了专业人员所面临的情况。第三，专业人员应考虑指导的制作方法和方法。尽管指导的实质质量很重要，但指导的制作方法也同样重要。在这里，专业人员应询问指导是否在谁准备了指导以及谁为其发展做出了贡献方面足够包容，以及它是否经过严格的开发，因此使用了适当的流程、原则和证据。
提出和回答这些问题可能具有挑战性，尤其是在疫情期间。此外，指导并不能解决所有问题：专业人员仍需要在决定个别情况下什么是最好的方面行使自己的判断，无论是否涉及 COVID-19。但是，这些判断可以并且应该得到指导的启发（和限制），希望这些初步观察结果能为时间紧迫的专业人员提供一些有用的指导。
