Health and Research Ethics Centre of Bordeaux, Bordeaux, France.
University Hospital Centre of Bordeaux, Bordeaux, France.
BMC Med Ethics. 2024 Nov 19;25(1):133. doi: 10.1186/s12910-024-01136-7.
INTRODUCTION: The COVID-19 pandemic generated overflow of healthcare systems in several countries. As the ethical debates focused on prioritisation for access to care with scarce medical resources, numerous recommendations were created. Late 2021, the emergence of the Omicron variant whose transmissibility was identified but whose vaccine sensitivity was still unknown, reactivated debates. Fears of the need to prioritise patients arose, particularly in France. Especially, a debate began about the role of vaccination status in the prioritisation strategy. MATERIAL AND METHODS: The Ethics Committee (EC) of the University Hospital of Bordeaux (UHB), France, identified prioritisation criteria in the literature (some recommended, such as being a healthcare worker (HCW) or having consented to research, while others were discouraged, such as age with a threshold effect or vaccination status). A survey was sent within the institution in January 2022 to explore frontline physicians' adherence to these prioritisation criteria. The decision making conditions were also surveyed. RESULTS: In 15 days, 78/165 (47.3%) frontline physicians responded, and more widely 1286/12946 (9.9%) professionals. A majority of frontline physicians were opposed to prioritising HCWs (54/75, 72%) and even more opposed to participating in research (69/76, 89.6%). Conversely, the results were very balanced for non-recommended criteria (respectively 39/77, 50.7% and 34/69 49.3% in favour for age with a threshold effect and for vaccination status). Decisions were considered to be multi-professional and multi-disciplinary for 65/76, 85.5% and 53/77, 68.8% of frontline physicians. Responders expressed opposition to extending decision-making to representatives of patients, civil society or HCWs not involved in care. DISCUSSION: Prioritisation recommendations in case of scarce medical resources were not necessarily approved by the frontline physicians, or by the other HCWs. This questions the way ethical recommendations should be communicated and discussed at a local scale, but it also questions these recommendations themselves. The article also reports the experience of seeking HCWs opinions on a sensitive ethical debate in a period of crisis.
引言:COVID-19 大流行导致多个国家的医疗系统不堪重负。随着人们围绕稀缺医疗资源的分配展开伦理辩论,大量建议被提出。2021 年末,出现了奥密克戎变异株,虽然其传播性已经确定,但疫苗敏感性仍不清楚,这再次引发了辩论。人们担心需要对患者进行优先排序,特别是在法国。特别是,关于疫苗接种状态在优先排序策略中的作用的辩论开始了。
材料和方法:法国波尔多大学医院(UHB)的伦理委员会(EC)在文献中确定了优先排序标准(一些建议,如医护人员(HCW)或同意进行研究,而另一些则不鼓励,如年龄有阈值效应或疫苗接种状态)。2022 年 1 月,该机构内部进行了一项调查,以了解一线医生对这些优先排序标准的遵守情况。还调查了决策条件。
结果:在 15 天内,78/165(47.3%)名一线医生做出了回应,更广泛地说,1286/12946(9.9%)名专业人员做出了回应。大多数一线医生反对优先考虑 HCW(54/75,72%),甚至更反对参与研究(69/76,89.6%)。相反,对于非推荐标准的结果则非常平衡(分别为 39/77,50.7%和 34/69,49.3%,赞成年龄有阈值效应和疫苗接种状态)。对于 65/76,85.5%和 53/77,68.8%的一线医生来说,决策被认为是多专业和多学科的。回应者表示反对将决策扩展到患者、公民社会或未参与护理的 HCW 的代表。
讨论:在医疗资源稀缺的情况下的优先排序建议并不一定得到一线医生或其他 HCW 的认可。这不仅对在当地范围内传达和讨论伦理建议的方式提出了质疑,也对这些建议本身提出了质疑。本文还报告了在危机时期寻求 HCW 对敏感伦理辩论的意见的经验。
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