COVID-19;
do not resuscitate;
ethics;
healthcare;
Pandemic;
NOT-RESUSCITATE ORDERS;
ASSOCIATION;
DECISIONS;
D O I:
10.3389/fpubh.2021.560405
中图分类号:
R1 [预防医学、卫生学];
学科分类号:
1004 ;
120402 ;
摘要:
Ethics are considered a basic aptitude in healthcare, and the capacity to handle ethical dilemmas in tough times calls for an adequate, responsible, and blame-free environment. While do-not-resuscitate (DNR) decisions are made in advance in certain medical situations, in particular in the setting of poor prognosis like in advanced oncology, the discussion of DNR in relation to acute medical conditions, the COVID-19 pandemic in this example, might impose ethical dilemmas to the patient and family, healthcare providers (HCPs) including physicians and nurses, and to the institution. The literature on DNR decisions in the more recent pandemics and outbreaks is scarce. DNR was only discussed amid the H1N1 influenza pandemic in 2009, with clear global recommendations. The unprecedented condition of the COVID-19 pandemic leaves healthcare systems worldwide confronting tough decisions. DNR has been implemented in some countries where the healthcare system is limited in capacity to admit, and thus intubating and resuscitating patients when needed is jeopardized. Some countries were forced to adopt a unilateral DNR policy for certain patient groups. Younger age was used as a discriminator in some, while general medical condition with anticipated good outcome was used in others. The ethical challenge of how to balance patient autonomy vs. beneficence, equality vs. equity, is a pressing concern. In the current difficult situation, when cases top 100 million globally and the death toll surges past 2.7 million, difficult decisions are to be made. Societal rather than individual benefits might prevail. Pre-hospital triaging of cases, engagement of other sectors including mental health specialists and religious scholars to support patients, families, and HCPs in the frontline might help in addressing the psychological stress these groups might encounter in addressing DNR in the current situation.
机构:
Carol Davila Univ Med & Pharm, Bucharest, Romania
Natl Inst Legal Med, Bucharest, RomaniaCarol Davila Univ Med & Pharm, Bucharest, Romania
Hostiuc, Sorin
Negoi, Ionut
论文数: 0引用数: 0
h-index: 0
机构:
Carol Davila Univ Med & Pharm, Bucharest, Romania
Floreasca Clin Emergency Hosp, Bucharest, RomaniaCarol Davila Univ Med & Pharm, Bucharest, Romania
Negoi, Ionut
Maria-Isaila, Oana
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h-index: 0
机构:
Carol Davila Univ Med & Pharm, Bucharest, Romania
Natl Inst Legal Med, Bucharest, RomaniaCarol Davila Univ Med & Pharm, Bucharest, Romania
Maria-Isaila, Oana
Diaconescu, Ioana
论文数: 0引用数: 0
h-index: 0
机构:Carol Davila Univ Med & Pharm, Bucharest, Romania
Diaconescu, Ioana
Hostiuc, Mihaela
论文数: 0引用数: 0
h-index: 0
机构:
Carol Davila Univ Med & Pharm, Bucharest, Romania
Floreasca Clin Emergency Hosp, Bucharest, RomaniaCarol Davila Univ Med & Pharm, Bucharest, Romania
Hostiuc, Mihaela
Drima, Eduard
论文数: 0引用数: 0
h-index: 0
机构:
Univ Galatzi, Galati, RomaniaCarol Davila Univ Med & Pharm, Bucharest, Romania
机构:
St Michaels Hosp, Ctr Clin Eth, Bond 307-G,30 Bond St, Toronto, ON M5B 1W8, Canada
Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, CanadaSt Michaels Hosp, Ctr Clin Eth, Bond 307-G,30 Bond St, Toronto, ON M5B 1W8, Canada
Robertson, Jamie
Flint, Alastair J.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Hlth Network, Ctr Mental Hlth, Toronto, ON, Canada
Univ Toronto, Dept Psychiat, Toronto, ON, CanadaSt Michaels Hosp, Ctr Clin Eth, Bond 307-G,30 Bond St, Toronto, ON M5B 1W8, Canada
Flint, Alastair J.
Blumberger, Daniel
论文数: 0引用数: 0
h-index: 0
机构:
Univ Toronto, Dept Psychiat, Toronto, ON, Canada
Ctr Addict & Mental Hlth, Toronto, ON, CanadaSt Michaels Hosp, Ctr Clin Eth, Bond 307-G,30 Bond St, Toronto, ON M5B 1W8, Canada
Blumberger, Daniel
Bhat, Venkat
论文数: 0引用数: 0
h-index: 0
机构:
Univ Toronto, Dept Psychiat, Toronto, ON, Canada
St Michaels Hosp, Mental Hlth & Addict Serv, Toronto, ON, CanadaSt Michaels Hosp, Ctr Clin Eth, Bond 307-G,30 Bond St, Toronto, ON M5B 1W8, Canada
Bhat, Venkat
CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE,
2021,
66
(08):
: 701
-
706
机构:
Kyoto Univ, Grad Sch Letters, Kyoto, Japan
Kyoto Univ, Grad Sch Letters, Yoshida Honmachi, Kyoto 6068501, JapanKyoto Univ, Grad Sch Letters, Kyoto, Japan