Ethical dilemmas due to the Covid-19 pandemic

被引:178
|
作者
Robert, Rene [1 ,2 ,3 ]
Kentish-Barnes, Nancy [4 ,5 ]
Boyer, Alexandre [6 ,7 ]
Laurent, Alexandra [8 ,9 ]
Azoulay, Elie [4 ,5 ]
Reignier, Jean [10 ,11 ]
机构
[1] Univ Poitiers, Poitiers, France
[2] INSERM, CIC 1402, Poitiers, France
[3] CHU Poitiers, Serv Med Intens Reanimat, Poitiers, France
[4] CHU St Louis, AP HP, Serv Reanimat Med, Paris, France
[5] Grp Rech Famirea, Paris, France
[6] Univ Bordeaux, Bordeaux, France
[7] CHU Bordeaux, Serv Med Intens Reanimat, Bordeaux, France
[8] Univ Bourgogne Franche Comte, Lab Psy DREPI, F-7458 Dijon, France
[9] Serv Reanimat Chirurg, Dijon, France
[10] Univ Nantes, Nantes, France
[11] CHU Nantes, Serv Med Intens Reanimat, Nantes, France
关键词
Covid-19; Pandemic; ICU; Ethics; Triage; Withdrawal of life support; End-of-life; Family-centered care; Burnout; INTENSIVE-CARE-UNIT; MENTAL-HEALTH-CARE; CRITICALLY-ILL; POSTTRAUMATIC STRESS; PALLIATIVE CARE; FAMILY-MEMBERS; DEATH; RECOMMENDATIONS; PROFESSIONALS; DISASTERS;
D O I
10.1186/s13613-020-00702-7
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
The devastating pandemic that has stricken the worldwide population induced an unprecedented influx of patients in ICUs, raising ethical concerns not only surrounding triage and withdrawal of life support decisions, but also regarding family visits and quality of end-of-life support. These ingredients are liable to shake up our ethical principles, sharpen our ethical dilemmas, and lead to situations of major caregiver sufferings. Proposals have been made to rationalize triage policies in conjunction with ethical justifications. However, whatever the angle of approach, imbalance between utilitarian and individual ethics leads to unsolvable discomforts that caregivers will need to overcome. With this in mind, we aimed to point out some critical ethical choices with which ICU caregivers have been confronted during the Covid-19 pandemic and to underline their limits. The formalized strategies integrating the relevant tools of ethical reflection were disseminated without deviating from usual practices, leaving to intensivists the ultimate choice of decision.
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页数:9
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