Haaser T, Constantinides Y, Lahmi L, Huguet F, de Crevoisier R, Dejean C, Escande A, Ghannam Y, Le Tallec P, Lorchel F, Mourman V, Thureau S, Lagrange J L
Service d'oncologie radiothérapie, hôpital Haut-Lévêque, centre hospitalier universitaire de Bordeaux, Pessac, France.
Espace éthique Île-de-France, Paris Université Sorbonne Nouvelle, Paris, France.
Cancer Radiother. 2022 Oct;26(6-7):834-840. doi: 10.1016/j.canrad.2022.07.010. Epub 2022 Sep 6.
Understood as a disruption of the conditions of care practice according to established protocols or procedures, crisis situations in radiation oncology departments can have multiple causes. Their seriousness can sometimes impose changes in the decision-making, organizational or technical paradigms. A possible consequence may be the need to make prioritization decisions in access to care, when there is a mismatch between the care needs of a population and the available health resources (whether technical or human). The specificities of care pathways and the wide variety of clinical situations in radiation oncology make these ethical decisions particularly difficult. Anticipation, collegial and multi-professional decision-making procedures or the integration of patient representatives in these prioritization processes are essential tools. Particular attention must be paid to the information to be provided to patients in a concern of transparency and respect. Prioritization situations are real tests for our departments. They go beyond the purely technical aspect of radiation oncology. They can lead to real ethical suffering for health professionals when their values come up against the limits imposed by crisis situations.
根据既定协议或程序，放射肿瘤学部门的危机情况若被视为护理实践条件的中断，可能有多种原因。其严重性有时可能会导致决策、组织或技术范式的改变。当人群的护理需求与可用的卫生资源（无论是技术资源还是人力资源）不匹配时，一个可能的后果可能是需要在获得护理方面做出优先排序的决定。放射肿瘤学护理途径的特殊性以及临床情况的广泛多样性使得这些伦理决策尤为困难。预先规划、 collegial（此处可能有误，推测为collegial，意为共同的、集体的）和多专业决策程序或让患者代表参与这些优先排序过程是必不可少的工具。必须特别关注为患者提供的信息，以确保透明度和尊重。优先排序情况对我们的部门来说是真正的考验。它们超越了放射肿瘤学的纯技术层面。当卫生专业人员的价值观与危机情况所带来的限制相冲突时，这些情况可能会给他们带来真正的伦理痛苦。
