O'Neal Lauren, Heisler Michele, Mishori Ranit, Haar Rohini J
School of Public Health, University of California Berkeley, Berkeley, CA, USA.
Physicians for Human Rights, New York, NY, USA.
Int J Emerg Med. 2021 Mar 24;14(1):18. doi: 10.1186/s12245-021-00341-0.
The COVID-19 pandemic has generated worldwide scarcity of critical resources to protect against and treat disease. Shortages of face masks and other protective equipment place health workers, already on the frontline of the disease, at higher risk. Moral distress from making difficult decisions about allocating scarce resources and care to patients ill with COVID-19 can further add to burdens health workers face. This study investigates clinical health workers' risk perceptions and concerns about the ethics of their clinical decision-making, the actions of their institutions to address resource scarcity concerns during the COVID-19 pandemic, and their ability to voice safety concerns, as well as their own views on how scarce resources should be allocated.
An online survey was open to health care workers who provide clinical care to patients, with no specialty training or geographic location requirements, from May 19 to June 30, 2020. Participants were recruited through purposive sampling using medical association and institutional email lists, and by snowball sampling.
Of 839 participants, a majority were physicians (540, 69.4%) working in academic medical centers (270, 35.2%) or private health systems in the community (234, 30.5%) in the USA (760, 90.7%). Most reported being concerned about their own health (494, 73.6%) and about the possibility of spreading COVID-19 to family and friends (534, 85.9%) during the pandemic. All respondents reported shortages or rationing of at least one type of medical resource (e.g., sanitizing supplies and personal protective equipment). More than half of respondents (351, 53.9%) did not feel they received sufficient training in how to allocate scarce resources in the pandemic. Many felt moral distress related to conflicts between institutional constraints and what they believed was right (459, 66.5%). Though a majority (459, 67.7%) reported feeling "comfortable" internally communicating with their administration about safety issues, far fewer reported feeling "confident" speaking publicly about safety issues without retaliation from their institution (255, 37.3%).
In the face of limited resources, surveyed health care workers reported concern about their own and their families' health from exposure. Securing adequate protective equipment must be a high priority for pandemic management. In addition, more governmental and facility-level ethical guidance is required for allocation of resources given ongoing scarcity, and facilities must create conditions so health care workers can speak openly about safety issues without fear of retaliation.
新冠疫情导致全球范围内用于预防和治疗疾病的关键资源短缺。口罩和其他防护设备的短缺使身处疾病一线的医护人员面临更高风险。在为感染新冠病毒的患者分配稀缺资源和护理时做出艰难决策所带来的道德困扰，会进一步加重医护人员面临的负担。本研究调查了临床医护人员对自身临床决策伦理的风险认知和担忧、其所在机构在新冠疫情期间应对资源短缺问题的行动、他们表达安全担忧的能力，以及他们对稀缺资源应如何分配的看法。
2020年5月19日至6月30日，一项在线调查面向为患者提供临床护理的医护人员开放，无专业培训或地理位置要求。通过使用医学协会和机构电子邮件列表进行目的抽样以及滚雪球抽样的方式招募参与者。
在839名参与者中，大多数是在美国（760人，占90.7%）学术医疗中心（270人，占35.2%）或社区私立卫生系统（234人，占30.5%）工作的医生（540人，占69.4%）。大多数人报告担心自己的健康（494人，占73.6%）以及在疫情期间将新冠病毒传播给家人和朋友的可能性（534人，占85.9%）。所有受访者都报告至少有一种医疗资源（如消毒用品和个人防护设备）存在短缺或定量配给情况。超过一半的受访者（351人，占53.9%）认为自己在如何在疫情期间分配稀缺资源方面没有得到足够的培训。许多人因机构限制与他们认为正确的事情之间的冲突而感到道德困扰（459人，占66.5%）。尽管大多数人（459人，占67.7%）报告在内部与管理层就安全问题进行沟通时感到“自在”，但报告在公开谈论安全问题而不会受到机构报复时感到“自信”的人要少得多（255人，占37.3%）。
面对资源有限的情况，接受调查的医护人员报告担心自己和家人因接触而健康受损。确保获得足够的防护设备必须成为疫情管理的高度优先事项。此外，鉴于资源持续短缺，在资源分配方面需要更多政府层面和机构层面的伦理指导，并且机构必须创造条件，使医护人员能够公开谈论安全问题而不必担心遭到报复。
