Fagan Johannes J, Maswime Salome, Shrime Mark G
Division of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Division of Global Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
J Coll Med S Afr. 2024 Mar 6;2(1):12. doi: 10.4102/jcmsa.v2i1.12. eCollection 2024.
The serves as a guide to ethical medical practice. It primarily addresses the duties of the physician in relation to an individual physician-patient relationship and implicitly advocates a 'first come, first served' model. It assumes the availability of adequate resources to treat all patients. However, no health system can meet all the requirements of its intended beneficiaries, and resource allocation, priority-setting and triaging are inevitable. Yet the 'does not permit considerations of age, disease or disability, gender …, social standing or any other factor' to be considered. Neither does it permit consideration of 'financial toxicity of treatment' on patients, families and struggling healthcare systems. Making resource allocation, priority-setting, and triaging decisions is ethically complex. Yet in many resource-limited settings, such difficult and ethical judgement calls are left to individual physicians to make; this applies especially in low- and middle-income countries where practitioners are often faced with overwhelming burdens of disease and simply cannot treat everyone requiring care. The should be amended to recognise limitations of physicians to deliver care because of health system constraints and should speak not only of a physician's duty towards the individual patient but also to broader society. It should provide ethical guidance to those practising in limited resource settings about triaging, protecting elective care, ensuring training of well-rounded physicians, ensuring financial wellness of patients and healthcare systems and ensuring accountability for health and wellness of patients and healthcare systems.
该准则是道德医疗实践的指南。它主要涉及医生在个体医患关系中的职责，并含蓄地倡导一种“先到先得”的模式。它假定有足够的资源来治疗所有患者。然而，没有哪个卫生系统能够满足其预期受益者的所有需求，资源分配、确定优先次序和进行分诊是不可避免的。然而，该准则“不允许考虑年龄、疾病或残疾、性别……、社会地位或任何其他因素”。它也不允许考虑治疗对患者、家庭和陷入困境的医疗系统的“经济负担”。做出资源分配、确定优先次序和分诊决策在伦理上是复杂的。然而，在许多资源有限的环境中，这种艰难的伦理判断留给了个体医生来做；在低收入和中等收入国家尤其如此，那里的从业者常常面临着疾病的沉重负担，根本无法治疗每一个需要护理的人。该准则应加以修订，以认识到由于卫生系统的限制医生提供护理的局限性，并且不仅应提及医生对个体患者的责任，还应提及对更广泛社会的责任。它应为在资源有限环境中执业的人员提供关于分诊、保护选择性医疗、确保培养全面发展的医生、确保患者和医疗系统的财务健康以及确保对患者和医疗系统的健康和福祉负责的伦理指导。
