Luyckx Valerie A, Van Biesen Wim, Ponikvar Jadranka Buturovic, Heering Peter, Abu-Alfa Ali, Silberzweig Ji, Fontana Monica, Tuglular Serhan, Sever Mehmet Sukru
Nephrology Department, University Children's Hospital, University of Zurich, Zurich, Switzerland.
Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Clin Kidney J. 2024 Sep 27;17(10):sfae290. doi: 10.1093/ckj/sfae290. eCollection 2024 Oct.
With the increasing frequency and severity of disasters and the increasing number of patients living with kidney disease, on dialysis and with transplants around the world, the need for kidney care in humanitarian settings is increasing. Almost all humanitarian emergencies pose a threat to kidney health because all treatments are highly susceptible to interruption, and interruption can be deadly. Providing support for people requiring dialysis in humanitarian settings can be complex and is associated with many trade-offs. The global kidney care community must become familiar with the ethics, principles and duties essential to meeting the overarching goals of ethical and effective disaster relief. Ethics principles and values must be considered on the individual, public health and global levels. The wellbeing of a single patient must be considered in the context of the competing needs of many others, and optimal treatment may not be possible due to resource constraints. Public health ethics principles, including considerations of triage and resource allocation, maximization of benefit and feasibility, often become directly relevant at the bedside. Individuals delivering humanitarian relief must be well trained, competent, respectful and professional, while involved organizations need to uphold the highest professional and ethical standards. There may be dissonance between ethical guidance and practical realities in humanitarian settings, which for inexperienced individuals may present significant challenges. Sustaining dialysis care in emergencies brings these issues starkly to the fore. Preparedness for dialysis in emergencies is an ethical imperative that mandates multisectoral stakeholder engagement and action, development of surge response plans, clinical and ethics guidance, and transparent priority setting. This manuscript outlines common ethics challenges and considerations that apply in all humanitarian actions, and illustrates their relevance to kidney care as a whole, using examples of how these may apply to dialysis and kidney disaster relief efforts in humanitarian settings.
随着灾害发生的频率和严重程度不断增加，以及世界各地肾病患者、接受透析治疗的患者和接受肾移植的患者数量不断增多，人道主义环境下对肾脏护理的需求也在增加。几乎所有人道主义紧急情况都会对肾脏健康构成威胁，因为所有治疗都极易中断，而中断可能是致命的。在人道主义环境中为需要透析的人提供支持可能很复杂，且涉及诸多权衡。全球肾脏护理界必须熟悉实现合乎道德且有效的救灾总体目标所必需的伦理、原则和职责。必须在个人、公共卫生和全球层面考虑伦理原则和价值观。必须在众多其他人相互竞争的需求背景下考虑单个患者的福祉，而且由于资源限制，可能无法提供最佳治疗。公共卫生伦理原则，包括分诊和资源分配、效益最大化和可行性等考量，往往在床边直接相关。提供人道主义救援的个人必须训练有素、胜任工作、尊重他人且专业，而相关组织需要秉持最高的专业和伦理标准。在人道主义环境中，伦理指导与实际现实之间可能存在不一致，这对缺乏经验的个人可能构成重大挑战。在紧急情况下维持透析护理使这些问题凸显出来。紧急情况下的透析准备是一项伦理要求，它要求多部门利益相关者参与并采取行动，制定应急响应计划、临床和伦理指导，以及透明的优先事项设定。本手稿概述了适用于所有人道主义行动的常见伦理挑战和考量，并通过这些挑战和考量如何应用于人道主义环境中的透析和肾脏灾害救援工作的示例，说明它们与整个肾脏护理的相关性。
