Department of Global Health, Global Institute for Interdisciplinary Studies (GIIS), Kathmandu, Nepal.
Department of Infection and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Lalitpur, Nepal.
Front Public Health. 2022 Jun 27;10:873881. doi: 10.3389/fpubh.2022.873881. eCollection 2022.
During health emergencies such as the COVID-19 pandemic, healthcare workers face numerous ethical challenges while catering to the needs of patients in healthcare settings. Although the data recapitulating high-income countries ethics frameworks are available, the challenges faced by clinicians in resource-limited settings of low- and middle-income countries are not discussed widely due to a lack of baseline data or evidence. The Nepali healthcare system, which is chronically understaffed and underequipped, was severely affected by the COVID-19 pandemic in its capacity to manage health services and resources for needy patients, leading to ethical dilemmas and challenges during clinical practice. This study aimed to develop a standard guideline that would address syndemic ethical dilemmas during clinical care of COVID-19 patients who are unable to afford standard-of-care. A mixed method study was conducted between February and June of 2021 in 12 government designated COVID-19 treatment hospitals in central Nepal. The draft guideline was discussed among the key stakeholders in the pandemic response in Nepal. The major ethical dilemmas confronted by the study participants (50 healthcare professionals providing patient care at COVID-19 treatment hospitals) could be grouped into five major pillars of ethical clinical practice: rational allocation of medical resources, updated treatment protocols that guide clinical decisions, standard-of-care regardless of patient's economic status, effective communication among stakeholders for prompt patient care, and external factors such as political and bureaucratic interference affecting ethical practice. This living clinical ethics guideline, which has been developed based on the local evidence and case stories of frontline responders, is expected to inform the policymakers as well as the decision-makers positioned at the concerned government units. These ethics guidelines could be endorsed with revisions by the concerned regulatory authorities for the use during consequent waves of COVID-19 and other epidemics that may occur in the future. Other countries affected by the pandemic could conduct similar studies to explore ethical practices in the local clinical and public health context.
在 COVID-19 大流行等卫生紧急情况下，医疗保健工作者在医疗环境中满足患者需求时面临着众多伦理挑战。虽然可以获得 recapitulating 高收入国家伦理框架的数据，但由于缺乏基线数据或证据，资源有限的低收入和中等收入国家临床医生所面临的挑战并未得到广泛讨论。尼泊尔医疗保健系统长期人手不足且设备不足，在管理卫生服务和资源以满足有需要的患者方面受到 COVID-19 大流行的严重影响，导致临床实践中出现伦理困境和挑战。本研究旨在制定一项标准指南，以解决无法负担标准治疗的 COVID-19 患者临床护理中的综合征伦理困境。这是一项在 2021 年 2 月至 6 月期间在尼泊尔中部的 12 家政府指定 COVID-19 治疗医院进行的混合方法研究。该指南草案在尼泊尔大流行应对中的主要利益相关者中进行了讨论。研究参与者（在 COVID-19 治疗医院提供患者护理的 50 名医疗保健专业人员）面临的主要伦理困境可以分为五个主要的伦理临床实践支柱：医疗资源的合理分配、指导临床决策的更新治疗方案、无论患者经济状况如何都提供标准治疗、利益相关者之间进行有效的沟通以实现及时的患者护理、以及影响伦理实践的政治和官僚干预等外部因素。本临床伦理实践指南是根据当地证据和一线应对者的案例故事制定的，预计将为决策者以及相关政府部门的决策者提供信息。这些伦理准则可以在随后的 COVID-19 浪潮和未来可能发生的其他流行病中，由相关监管当局修订后采用。受大流行影响的其他国家可以进行类似的研究，以探讨当地临床和公共卫生背景下的伦理实践。
