Division of Pediatric Critical Care Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA.
J Med Ethics. 2022 Aug;48(8):557-565. doi: 10.1136/medethics-2020-106772. Epub 2021 Mar 22.
Programmes serving international patients are increasingly common throughout the USA. These programmes aim to expand access to resources and clinical expertise not readily available in the requesting patients' home country. However, they exist within the US healthcare system where domestic healthcare needs are unmet for many children. Focusing our analysis on US children's hospitals that have a societal mandate to provide medical care to a defined geographic population while simultaneously offering highly specialised healthcare services for the general population, we assume that, given their mandate, priority will be given to patients within their catchment area over other patients. We argue that beyond prioritising patients within their region and addressing inequities within US healthcare, US institutions should also provide care to children from countries where access to vital medical services is unavailable or deficient. In the paper, we raise and attempt to answer the following: (1) Do paediatric healthcare institutions have a duty to care for all children in need irrespective of their place of residence, including international patients? (2) If there is such a duty, how should this general duty be balanced against the special duty to serve children within a defined geographical area to which an institution is committed, when resources are strained? (3) Finally, how are institutional obligations manifest in paradigm cases involving international patients? We start with cases, evaluating clinical and contextual features as they inform the strength of ethical claim and priority for access. We then proceed to develop a general prioritisation framework based on them.
服务国际患者的项目在美国各地越来越普遍。这些项目旨在扩大资源和临床专业知识的获取途径，而这些资源和专业知识在患者的母国不易获得。然而，这些项目存在于美国的医疗保健系统中，而美国国内的许多儿童的医疗需求都未得到满足。我们专注于分析那些具有向特定地理区域的人群提供医疗服务的社会使命，同时为普通人群提供高度专业化医疗服务的美国儿童医院，我们假设，鉴于其使命，优先考虑的将是其服务区域内的患者，而不是其他患者。我们认为，除了在区域内优先考虑患者和解决美国医疗保健中的不平等问题外，美国医疗机构还应为那些在其母国无法获得或缺乏重要医疗服务的国家的儿童提供医疗服务。在本文中，我们提出并试图回答以下问题：（1）儿科医疗机构是否有责任照顾所有有需要的儿童，无论其居住地点如何，包括国际患者？（2）如果有这样的责任，在资源紧张的情况下，应如何平衡对特定地理区域内儿童的特殊服务义务与为所有有需要的儿童提供服务的一般义务？（3）最后，机构义务在涉及国际患者的范例案例中是如何体现的？我们从案例开始，评估临床和背景特征，以了解伦理主张的强度和获得优先权的依据。然后，我们根据这些案例制定一个一般的优先排序框架。
