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一种天主教视角:大流行时期资源稀缺下的分诊原则与道德困境。

A Catholic Perspective: Triage Principles and Moral Distress in Pandemic Scarcity.

作者信息

Kenny Nuala, Kotalik Jaro, Herx Leonie, Coelho Ramona, Leiva Rene

机构信息

Bioethics and Pediatrics, Ringgold Standard Institution, Dalhousie University, Halifax, Nova Scotia, Canada.

Centre for Healthcare Ethics, Ringgold Standard Institution, Lakehead University, Thunder Bay, Ontario, Canada.

出版信息

Linacre Q. 2021 May;88(2):214-223. doi: 10.1177/0024363921995714. Epub 2021 Mar 11.

Abstract

UNLABELLED

Striving to be faithful to the moral core of medicine and to spiritual, moral, and social teaching of the church, Catholic physicians see their role as an extension of the healing ministry of Jesus. When faced with a situation in which a large number of gravely ill people are seeking care, but optimal treatment such as ventilation in intensive care unit cannot be offered to all because of scarcity of resources, Catholic physicians recognize the need to consider the common good and to assign a priority to patients for whom such treatments would be most probably lifesaving. Making these evaluations, physicians will use only objective medical criteria regarding the benefits and risks to patients and will be mindful that all persons deserve equal respect for their dignity. Discrimination or prejudicial treatment against patients based on factors such as age, disability, race, gender, quality of life, and possible long-term survival cannot be morally justified. Triage process should incorporate respect for autonomy of both the patient and the professional and opportunity for an appeal of a triage decision. Other principles and values that will affect how a triage protocol is developed and applied are proportionality, equity, reciprocity, solidarity, subsidiarity, and transparency. The current coronavirus pandemic can provide valuable lessons and stimulus for reforms and renewal.

SUMMARY

Catholic physicians strive to continue the healing ministry of Jesus Christ and be faithful to the moral core of medicine. In situations such as pandemic, the scarcity of personnel and technological resources create serious challenges and even moral distress. Church teachings on dignity, the common good and protection of the vulnerable help guide decisions based on public medical criteria and shared decision-making.

摘要

未标注

天主教医生努力忠实于医学的道德核心以及教会的精神、道德和社会教义,他们将自己的角色视为耶稣治愈事工的延伸。当面对大量重症患者寻求治疗,但由于资源稀缺无法为所有人提供重症监护病房的最佳治疗(如通气)等情况时,天主教医生认识到有必要考虑共同利益,并为最有可能通过此类治疗挽救生命的患者确定优先顺序。在进行这些评估时,医生将仅使用关于患者受益和风险的客观医学标准,并牢记所有人的尊严都应得到平等尊重。基于年龄、残疾、种族、性别、生活质量和可能的长期生存等因素对患者进行歧视或偏见性治疗在道德上是不合理的。分诊过程应包含对患者和专业人员自主权的尊重以及对分诊决定提出上诉的机会。其他将影响分诊方案制定和应用的原则和价值观包括相称性、公平性、互惠性、团结性、辅助性和透明度。当前的新冠疫情可为改革和复兴提供宝贵的经验教训和动力。

总结

天主教医生努力延续耶稣基督的治愈事工,并忠实于医学的道德核心。在大流行等情况下,人员和技术资源的稀缺带来了严峻挑战,甚至造成道德困境。教会关于尊严、共同利益和保护弱势群体的教义有助于指导基于公共医学标准和共同决策的决定。

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