Ethical Considerations Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement

被引：111

作者：

Biddison, Lee Daugherty ^{[1
]}

Berkowitz, Kenneth A. ^{[2
]}

Courtney, Brooke ^{[3
]}

De Jong, Marla J. ^{[4
]}

Devereaux, Asha V. ^{[5
]}

Kissoon, Niranjan ^{[6
,7
]}

Roxland, Beth E. ^{[8
]}

Sprung, Charles L. ^{[9
]}

Dichter, Jeffrey R. ^{[10
,11
]}

Christian, Michael D. ^{[12
,13
]}

Powell, Tia ^{[14
]}

机构：

[1] Johns Hopkins Sch Med, Baltimore, MD 21287 USA

[2] NYU, Sch Med, Vet Hlth Adm, New York, NY USA

[3] US FDA, Off Counterterrorism & Emerging Threats, Off Commissioner, Silver Spring, MD USA

[4] US Air Force Sch Aerosp Med, Wright Patterson AFB, OH USA

[5] Sharp Hosp, Coronado, CA USA

[6] Univ British Columbia, BC Childrens Hosp, Vancouver, BC V5Z 1M9, Canada

[7] Univ British Columbia, Sunny Hill Hlth Ctr, Vancouver, BC V5Z 1M9, Canada

[8] NYU, Sch Law, Langone Med Ctr, New York, NY 10003 USA

[9] Hadassah Hebrew Univ, Med Ctr, Jerusalem, Israel

[10] Allina Hlth, Minneapolis, MN USA

[11] Aurora Hlth, Milwaukee, WI USA

[12] Canadian Armed Forces, Royal Canadian Med Serv, Toronto, ON, Canada

[13] Mt Sinai Hosp, Toronto, ON M5G 1X5, Canada

[14] Albert Einstein Coll Med, Montefiore Med Ctr, New York, NY USA

来源：

CHEST | 2014年 / 146卷 / 04期

关键词：

MASS CRITICAL-CARE; TASK-FORCE; JANUARY; 26-27; CONDUCTING RESEARCH; NATURAL DISASTERS; DEFINITIVE CARE; INFLUENZA; HEALTH; TRIAGE; ALLOCATION;

D O I：

10.1378/chest.14-0742

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND: Mass critical care entails time-sensitive decisions and changes in the standard of care that it is possible to deliver. These circumstances increase provider uncertainty as well as patients' vulnerability and may, therefore, jeopardize disciplined, ethical decision-making. Planning for pandemics and disasters should incorporate ethics guidance to support providers who may otherwise make ad hoc patient care decisions that overstep ethical boundaries. This article provides consensus-developed suggestions about ethical challenges in caring for the critically ill or injured during pandemics or disasters. The suggestions in this article are important for all of those involved in any pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS: We adapted the American College of Chest Physicians (CHEST) Guidelines Oversight Committee's methodology to develop suggestions. Twenty-four key questions were developed, and literature searches were conducted to identify evidence for suggestions. The detailed literature reviews produced 144 articles. Based on their expertise within this domain, panel members also supplemented the literature search with governmental publications, interdisciplinary workgroup consensus documents, and other information not retrieved through PubMed. The literature in this field is not suitable to support evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS: We report the suggestions that focus on five essential domains: triage and allocation, ethical concerns of patients and families, ethical responsibilities to providers, conduct of research, and international concerns. CONCLUSIONS: Ethics issues permeate virtually all aspects of pandemic and disaster response. We have addressed some of the most pressing issues, focusing on five essential domains: triage and allocation, ethical concerns of patients and families, ethical responsibilities to providers, conduct of research, and international concerns. Our suggestions reflect the consensus of the Task Force. We recognize, however, that some suggestions, including those related to end-of-life care, may be controversial. We highlight the need for additional research and dialogue in articulating values to guide health-care decisions during disasters. CHEST 2014; 146 (4_Suppl): e145S-e155S

引用

页码：E145S / E155S

页数：11

共 60 条

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