Lynch Julia F, Perera Isabel M, Iwashyna Theodore J
Department of Political Science and Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA.
Government Department, Cornell University, Ithaca, NY.
Crit Care Explor. 2021 Jun 8;3(6):e0466. doi: 10.1097/CCE.0000000000000466. eCollection 2021 Jun.
Shortages of equipment, medication, and staff under coronavirus disease 2019 may force hospitals to make wrenching decisions. Although bioethical guidance is available, published procedures for decision-making processes to resolve the time-sensitive conflicts are rare. Failure to establish decision-making procedures before scarcities arise exposes clinicians to moral distress and potential legal liability, entrenches existing systemic biases, and leaves hospitals without processes to guarantee transparency and consistency in the application of ethical guidelines. Formal institutional processes can reduce the panic, inequity, and irresolution that arise from confronting ethical conflicts under duress. Drawing on expertise in critical care medicine, bioethics, and political science, we propose a decision-making protocol to ensure fairness in the resolution of conflict, timely decision-making, and accountability to improve system response.
2019冠状病毒病期间，设备、药品和工作人员的短缺可能迫使医院做出痛苦的决定。尽管有生物伦理指导意见，但用于解决时间敏感型冲突的决策过程的公开程序却很少见。在短缺情况出现之前未能建立决策程序，会使临床医生面临道德困扰和潜在的法律责任，加深现有的系统性偏见，并且让医院在应用伦理准则时缺乏保证透明度和一致性的程序。正式的机构程序可以减少在压力下面对伦理冲突时产生的恐慌、不公平和犹豫不决。借鉴重症医学、生物伦理学和政治学方面的专业知识，我们提出了一个决策方案，以确保在冲突解决中做到公平、及时决策并实现问责，从而改善系统响应。
