Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Department of Surgery, Texas Christian University, Fort Worth, Texas, USA.
Clin Infect Dis. 2024 Aug 16;79(2):339-347. doi: 10.1093/cid/ciae162.
During pandemics, healthcare providers struggle with balancing obligations to self, family, and patients. While HIV/AIDS seemed to settle this issue, coronavirus disease 2019 (COVID-19) rekindled debates regarding treatment refusal. We searched MEDLINE, Embase, CINAHL Complete, and Web of Science using terms including obligation, refusal, HIV/AIDS, COVID-19, and pandemics. After duplicate removal and dual, independent screening, we analyzed 156 articles for quality, ethical position, reasons, and concepts. Diseases in our sample included HIV/AIDS (72.2%), severe acute respiratory syndrome (SARS) (10.2%), COVID-19 (10.2%), Ebola (7.0%), and influenza (7.0%). Most articles (81.9%, n = 128) indicated an obligation to treat. COVID-19 had the highest number of papers indicating ethical acceptability of refusal (60%, P < .001), while HIV had the least (13.3%, P = .026). Several reason domains were significantly different during COVID-19, including unreasonable risks to self/family (26.7%, P < .001) and labor rights/workers' protection (40%, P < .001). A surge in ethics literature during COVID-19 has advocated for permissibility of treatment refusal. Balancing healthcare provision with workforce protection is crucial in effectively responding to a global pandemic.
在大流行期间，医疗保健提供者在平衡自身、家庭和患者的义务方面面临困难。虽然艾滋病似乎解决了这个问题，但 2019 年冠状病毒病（COVID-19）重新引发了关于治疗拒绝的争论。我们使用包括义务、拒绝、艾滋病、COVID-19 和大流行在内的术语，在 MEDLINE、Embase、CINAHL Complete 和 Web of Science 上进行了搜索。在去除重复项并进行双重、独立筛选后，我们分析了 156 篇文章，以评估其质量、伦理立场、原因和概念。我们样本中的疾病包括艾滋病（72.2%）、严重急性呼吸综合征（SARS）（10.2%）、COVID-19（10.2%）、埃博拉（7.0%）和流感（7.0%）。大多数文章（81.9%，n=128）表明有治疗义务。COVID-19 有最多的论文表明拒绝具有伦理可接受性（60%，P<.001），而艾滋病则最少（13.3%，P=.026）。在 COVID-19 期间，几个原因领域有显著差异，包括对自身/家庭的不合理风险（26.7%，P<.001）和劳工权利/工人保护（40%，P<.001）。COVID-19 期间伦理学文献的激增主张治疗拒绝的许可性。在有效应对全球大流行时，平衡医疗服务提供与劳动力保护至关重要。
