GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France.
Nurs Ethics. 2022 Jun;29(4):833-843. doi: 10.1177/09697330211066575. Epub 2022 Mar 3.
The first COVID-19 wave started in February 2020 in France. The influx of patients requiring emergency care and high-level technicity led healthcare professionals to fear saturation of available care. In that context, the multidisciplinary thics-upport ell (EST) was created to help medical teams consider the decisions that could potentially be sources of ethical dilemmas.
The primary objective was to prospectively collect information on requests for EST assistance from 23 March to 9 May 2020. The secondary aim was to describe the Cell's functions during that period.
This observational, real-time study of requests for Cell consultations concerned ethical dilemmas arising during a public health crisis. The EST created a grid to collect relevant information (clinical, patient's/designated representative's preferences and ethical principles strained by the situation), thereby assuring that each EST asked the same questions, in the same order.
Only our university hospital's clinicians could request EST intervention.
The hospital Research Ethics Committee approved this study (no. CER-2020-107). The patient, his/her family, or designated representative was informed of this ethics consultation and most met with EST members, which enabled them to express their preferences and/or opposition.
FINDINGS/RESULTS: 33 requests (patients' mean age: 80.8 years; 29 had COVID-19: 24 with dyspnea, 30 with comorbidities). 17 Emergency Department solicitations concerned ICU admission, without reference to resource constraints; others addressed therapeutic proportionality dilemmas.
Intervention-request motives concerned limited resources and treatment intensity. Management revolved around three axes: the treatment option most appropriate for the patient, the feasibility of implementation, and dignified care for the patient.
COVID-19 crisis forced hospitals to envisage prioritization of ICU access. Established decision-making criteria and protocols do not enable healthcare professionals to escape ethical dilemmas. That acknowledgement highlights ethical risks, enhances the added-value of nursing and encourages all players to be vigilant to pursue collective deliberations to achieve clear and transparent decisions.
2020 年 2 月，法国出现了第一波 COVID-19 疫情。大量需要紧急护理和高度技术支持的患者涌入，导致医疗保健专业人员担心可用护理资源会饱和。在这种情况下，成立了多学科伦理支持小组（EST），以帮助医疗团队考虑可能引发伦理困境的决策。
前瞻性收集 2020 年 3 月 23 日至 5 月 9 日 EST 援助请求的信息。次要目标是描述该期间 EST 的功能。
这是一项关于公共卫生危机期间伦理困境咨询请求的观察性、实时研究。EST 制定了一个网格来收集相关信息（临床、患者/指定代表的偏好和受情况影响的伦理原则），从而确保每个 EST 都以相同的顺序提出相同的问题。
只有我们大学医院的临床医生才能请求 EST 干预。
医院伦理委员会批准了这项研究（编号 CER-2020-107）。患者、其家属或指定代表被告知这项伦理咨询，大多数人都与 EST 成员会面，使他们能够表达自己的偏好和/或反对意见。
共收到 33 份请求（患者平均年龄：80.8 岁；29 例 COVID-19：24 例呼吸困难，30 例合并症）。17 份来自急诊部门的咨询涉及 ICU 入院，没有提到资源限制；其他则涉及治疗比例困境。
干预请求的动机涉及有限的资源和治疗强度。管理围绕三个方面展开：最适合患者的治疗选择、实施的可行性以及患者的尊严护理。
COVID-19 危机迫使医院考虑 ICU 准入的优先级。既定的决策制定标准和协议并不能使医疗保健专业人员避免伦理困境。这种认识凸显了伦理风险，增强了护理的附加值，并鼓励所有参与者保持警惕，以进行集体讨论，从而做出明确和透明的决策。
