Bouchlaghem Mohamed Amine, Estey-Amyot Zoé, Ethier Erika, Anohim Miruna, Ouellet-Pelletier Marie-Laurence, Langlois Lyse, Pageau Félix
Faculty of Nursing Science, Université Laval, Quebec City, QC, Canada.
VITAM - Centre de Recherche en Santé Durable, Quebec City, QC, Canada.
BMC Med Ethics. 2025 Jan 25;26(1):10. doi: 10.1186/s12910-024-01149-2.
The COVID-19 pandemic has led governments worldwide to make ethically controversial decisions. As a result, healthcare professionals are facing several ethical dilemmas, especially in terms of healthcare services provided to senior citizens. Thus, the aim of this review is to identify and categorize ethical dilemmas as well as propose solutions regarding health care services for elderly individuals.
A qualitative systematic review of the literature was undertaken in the first tier of the pandemic. All identified scientific and editorial articles published in English or French between December 2019 and October 2021 were included. An article was excluded if it was commercial, did not address an issue in the care of the elderly or present any qualitative data. Article eligibility was determined through a process of triangulation among three independent reviewers.
Initially, 69 articles met our inclusion criteria and were selected for this review. These studies can be divided into 2 distinct categories: scientific articles (17 studies) and expert opinion articles (52 articles). However, due to the large quantity of qualitative data that was extracted, only the results from the scientific literature are presented here. The analysis of the data of 17 studies has allowed the emergence of 2 main themes of ethical dilemmas: 1) access to care (3 subthemes: A) triage decisions for admission, B) access to the intensive care unit and C) vaccine allocation) and 2) infection control decisions (2 subthemes: (D) isolation and E) autonomy). Our results also revealed 4 categories of potential solutions to the encountered ethical dilemmas, namely, optimal protocols, enhanced communication, caregiver support and technological assistance (virtual team-based, AI).
The ethical dilemmas that emerged from our results highlight the interest of a serious international discussion around the phenomena of ageism and its potential ethical implications for health care workers (be it under normal circumstances or exceptional circumstances such as those of a pandemic). We highly recommend that future research be undertaken to test the efficacy of the proposed solutions in providing age-friendly, dilemma-free health care and environments.
新冠疫情致使世界各国政府做出了存在伦理争议的决策。因此，医护人员面临着诸多伦理困境，尤其是在为老年人提供医疗服务方面。故而，本综述的目的是识别和分类伦理困境，并针对老年人的医疗服务提出解决方案。
在疫情的第一阶段对文献进行了定性系统综述。纳入了2019年12月至2021年10月期间以英文或法文发表的所有已识别的科学和编辑文章。如果文章是商业性的、未涉及老年人护理问题或未呈现任何定性数据，则将其排除。文章的合格性由三位独立评审员通过三角互证法确定。
最初，69篇文章符合我们的纳入标准并被选入本综述。这些研究可分为2个不同类别：科学文章（17项研究）和专家意见文章（52篇文章）。然而, 由于提取的定性数据量庞大，这里仅呈现科学文献的结果。对17项研究的数据进行分析后，出现了2个主要的伦理困境主题：1）获得医疗服务（3个子主题：A）入院分诊决策、B）进入重症监护病房的机会和C）疫苗分配）以及2）感染控制决策（2个子主题：D）隔离和E）自主权）。我们的结果还揭示了针对所遇到的伦理困境的4类潜在解决方案，即优化方案、加强沟通、护理人员支持和技术援助（基于虚拟团队、人工智能）。
我们的结果中出现的伦理困境凸显了围绕年龄歧视现象及其对医护人员潜在伦理影响（无论是在正常情况下还是在大流行等特殊情况下）展开严肃国际讨论的意义。我们强烈建议未来开展研究，以测试所提出的解决方案在提供对年龄友好、无困境的医疗保健和环境方面的有效性。
