Operationalizing Equity in Surgical Prioritization

IF 0.3 Q4 MEDICAL ETHICS
Kayla Wiebe, Simon Kelley, Annie Fecteau, Mark Levine, Iram Blajchman, Randi Zlotnik Shaul, Roxanne Kirsch
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引用次数: 1

Abstract

The allocation of critical care resources and triaging patients garnered a great deal of attention during the COVID-19 pandemic, but there is a paucity of guidance regarding the ethical aspects of resource allocation and patient prioritization in ‘normal’ circumstances for Canadian healthcare systems. One context where allocation and prioritization decisions are required are surgical waitlists, which have been globally exacerbated due to the COVID-19 pandemic. In this paper, we detail the process used to develop an ethics framework to support prioritization for elective surgery at The Hospital for Sick Children, Toronto, a tertiary pediatric hospital. Our goal was to provide guidance for the more value-laden aspects of prioritization, particularly when clinical urgency alone is insufficient to dictate priority. With this goal in mind, we worked to capture familial, relational, and equity considerations. As part of our institution’s concerted efforts to ethically and effectively address our surgical backlog, an ethics working group was formed comprising clinicians from surgery, anesthesiology, intensive care, a hospital bioethicist, a parent advisor, and an academic bioethics researcher. A reflective equilibrium process was used to develop an ethics framework. To this end, the same methodology was used to create a support for patient prioritization that identifies clinically and morally relevant factors for prioritization among medically similar surgical cases, with a substantive goal being to identify and redress health inequities in surgical prioritization, inasmuch as this is possible. While further steps are needed to validate several aspects of the framework, our research suggests that an ethics framework grounded in the practical realities of hospital operations provides consistency, transparency, and needed support for decisions that are often left to individual clinicians, as well as an opportunity to reflect upon the presence of health inequities in all domains of healthcare delivery.
手术优先顺序的操作公平性
在COVID-19大流行期间,重症监护资源的分配和患者分诊引起了极大的关注,但加拿大医疗保健系统在“正常”情况下缺乏关于资源分配和患者优先级的道德方面的指导。需要做出分配和优先排序决定的一个情况是手术等候名单,由于COVID-19大流行,这一情况在全球范围内加剧了。在本文中,我们详细介绍了用于制定道德框架的过程,以支持多伦多儿童医院(一家三级儿科医院)择期手术的优先顺序。我们的目标是为优先次序的更有价值的方面提供指导,特别是当临床紧迫性本身不足以决定优先次序时。有了这个目标,我们努力捕捉家庭、关系和公平的考虑。为了从伦理上有效地解决手术积压问题,我们组织了一个伦理工作组,成员包括来自外科、麻醉科、重症监护室的临床医生、一名医院生物伦理学家、一名家长顾问和一名学术生物伦理学研究员。一个反思的平衡过程被用来发展一个伦理框架。为此目的,采用同样的方法为患者优先排序提供支持,在医学上类似的手术病例中确定临床和道德上相关的优先因素,其实质性目标是尽可能确定和纠正手术优先排序方面的卫生不公平现象。虽然需要进一步的步骤来验证该框架的几个方面,但我们的研究表明,基于医院运营实际情况的伦理框架为通常留给临床医生个人的决策提供了一致性、透明度和所需的支持,同时也为反思医疗保健服务所有领域中存在的卫生不平等提供了机会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Canadian Journal of Bioethics
Canadian Journal of Bioethics Arts and Humanities-Philosophy
CiteScore
0.50
自引率
0.00%
发文量
46
审稿时长
35 weeks
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