Paediatric Bioethics Centre, Great Ormond Street Hospital, London, UK.
Center for Bioethics, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
AJOB Empir Bioeth. 2022 Jul-Sep;13(3):179-195. doi: 10.1080/23294515.2022.2063996. Epub 2022 Apr 25.
The COVID-19 pandemic has posed several ethical challenges worldwide. Understanding care providers' experiences during health emergencies is key to develop comprehensive ethical guidelines for emergency and disaster circumstances. To identify and synthetize available empirical data on ethical challenges experienced by health care workers (HCWs) providing direct patient care in health emergencies and disaster scenarios that occurred prior to COVID-19, considering there might be a significant body of evidence yet to be reported on the current pandemic. A rapid review of qualitative studies and thematic synthesis was conducted. Medline and Embase were searched from inception to December 2020 using "public health emergency" and "ethical challenges" related keywords. Empirical studies examining ethical challenges experienced by frontline HCWs during health emergencies or disasters were included. We considered that ethical challenges were present when participants and/or authors were uncertain regarding how one should behave, or when different values or ethical principles are compromised when making decisions. After deduplication 10,160 titles/abstracts and 224 full texts were screened. Twenty-two articles were included, which were conducted in 15 countries and explored eight health emergency or disaster events. Overall, a total of 452 HCWs participants were included. Data were organized into five major themes with subthemes: HCWs' vulnerability, Duty to care, Quality of care, Management of healthcare system, and Sociocultural factors. HCWs experienced a great variety of clinical ethical challenges in health emergencies and disaster scenarios. Core themes identified provide evidence-base to inform the development of more comprehensive and supportive ethical guidelines and training programmes for future events, that are grounded on actual experiences of those providing care during emergency and disasters.
COVID-19 大流行在全球范围内带来了若干伦理挑战。了解卫生应急期间医护人员的经历是为紧急情况和灾害情况下制定全面伦理准则的关键。本研究旨在确定并综合分析在 COVID-19 之前发生的卫生应急和灾害场景中直接护理患者的医护人员（HCWs）所经历的伦理挑战的现有经验数据，考虑到可能有大量证据尚未报道当前的大流行。对定性研究进行了快速回顾和主题综合分析。使用与“公共卫生应急”和“伦理挑战”相关的关键字，从开始到 2020 年 12 月，在 Medline 和 Embase 中进行了搜索。纳入了研究卫生应急或灾害期间一线 HCWs 所经历的伦理挑战的实证研究。我们认为，当参与者和/或作者对应该如何行为不确定，或者在做出决策时不同的价值观或伦理原则受到损害时，就存在伦理挑战。经过去重后，筛选了 10,160 篇标题/摘要和 224 篇全文。共纳入 22 篇文章，这些文章在 15 个国家进行，探讨了 8 次卫生应急或灾害事件。共有 452 名 HCWs 参与者纳入研究。数据被组织成五个主要主题和子主题：HCWs 的脆弱性、护理义务、护理质量、医疗保健系统管理和社会文化因素。HCWs 在卫生应急和灾害场景中经历了各种各样的临床伦理挑战。确定的核心主题为未来事件提供了循证基础，为制定更全面和支持性的伦理准则和培训计划提供了信息，这些准则和计划基于在应急和灾害期间提供护理的人的实际经验。
