Simon F, Plisson L, Heutte N, Leboulanger N, Barry B, Babin E, Parietti-Winkler C
Service d'otorhinolaryngologie pédiatrique et chirurgie cervico-faciale, hôpital Necker-Enfants Malades, centre - université de Paris, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
Service d'otorhinolaryngologie et chirurgie cervico-faciale, CHU de Côte-de-Nacre, Caen, France.
Ethique Sante. 2021 Jun;18(2):134-141. doi: 10.1016/j.etiqe.2021.04.006. Epub 2021 Apr 20.
The current new SARS-CoV-2 pandemic has had a profound impact on medical practice. The objective was to analyse the ethical questions raised by the French ENT community during the first wave of COVID-19 infections.
Four open-ended questions concerning ethical considerations in ENT were sent out in April 2020: (i) difficulties to care for COVID-19 positive patients; (ii) impact of the health crisis on COVID-19 negative patients; (iii) communication within the healthcare teams and with hospital staff; and (iv) management of information by the press, or national ENT societies. A thematic analysis was carried out and crossed with the epidemiological data of each respondent.
Thirty-one responses from 13 different French Departments, including 21 from public institutions and 10 from private practice, median age of 45 and 17 men for 14 women, were analysed. The main ethical considerations concerned the management by ENTs of COVID-19 positive patients, the modification of practices in consultation and in the operating room, the fear of loss of chance for COVID-19 negative patients, the appropriate use of teleconsultations and teleworking and the consequences of fake-news for the population.
In preparation of possible future pandemic outbreaks, key ethical aspects are to adapt patient management to local resources and infection prevalence, and circulate clear institutional guidelines.
当前新型严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行对医疗实践产生了深远影响。目的是分析法国耳鼻喉科界在第一波新冠病毒疾病（COVID-19）感染期间提出的伦理问题。
2020年4月发出了四个关于耳鼻喉科伦理考量的开放式问题：（i）护理COVID-19阳性患者的困难；（ii）健康危机对COVID-19阴性患者的影响；（iii）医疗团队内部以及与医院工作人员的沟通；（iv）媒体或国家耳鼻喉科协会的信息管理。进行了主题分析，并与每位受访者的流行病学数据进行了交叉分析。
分析了来自法国13个不同部门的31份回复，包括21份来自公共机构的回复和10份来自私人诊所的回复，受访者的年龄中位数为45岁，男性17人，女性14人。主要的伦理考量涉及耳鼻喉科医生对COVID-19阳性患者的管理、门诊和手术室诊疗方式的改变、对COVID-19阴性患者失去治疗机会的担忧、远程会诊和远程工作的合理使用以及虚假新闻对民众的影响。
为应对未来可能爆发的大流行，关键的伦理方面是使患者管理适应当地资源和感染流行情况，并传播明确的机构指南。
