Health care and the ethical implications of treatment spaces

IF 1.7 2区 哲学 Q2 ETHICS
Bioethics Pub Date : 2025-02-17 DOI:10.1111/bioe.13401
Ruth Chadwick
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引用次数: 0

Abstract

The recent advertisement in the United Kingdom for nurses to give corridor care1 has revived discussion of the ethical issues associated with the spaces in which health care is delivered. While we are sadly used to seeing, on television screens at least, treatment given in situations of war and disasters—in conditions of extreme deprivation—there are concerns about the normalisation of less than optimal situations for delivery of care in relatively rich countries in peace time. Rachelle Barina has written of the distinction between places and spaces:

‘By place, I mean the material qualities, setting and location of health care delivery. The various places in which health care is delivered are also distinct spaces. By space, I mean not only physical and geographical qualities, but also the ideas, activities and symbols that form, result from, and function within places’.2

The distinction between the implications of old-style Nightingale ward arrangements and more intimate settings is a familiar one, but Barina also writes about the properties of Intensive Care Units, which are not just particular spaces but ones which have symbolic meaning around the use of the ventilator for example. Indeed, this was very evident during the COVID-19 pandemic.

‘Corridor care’ or care in spaces that have been referred to as ‘temporary escalation spaces’3 clearly has implications not only for patients but also for health care providers and for society more generally. As regards patients, concerns raised have included those related to privacy and dignity (although it has to be acknowledged that in a standard ward the use of a curtain may give visual but not verbal privacy). There are also issues about access to necessary equipment. The term ‘corridor’ symbolises a passing through, a way past rooms which one might want to enter. It is in those rooms that it might be imagined that desired resources might be found—but not accessible.

For health care providers, having one's role designated as a ‘corridor carer’ may give rise to diminished job satisfaction and frustration, through recognising that one does not have the wherewithal to give the care to the standard one would want. Sheather and Phillips, reviewing a guide to the ethics of corridor care published by NHS England,4 have argued that ‘[S]afe and good quality care cannot co-exist with treatment in corridors’.5

A key issue here is normalisation. When do ‘temporary escalation spaces’ become a permanent feature? This is an issue for consideration by managers, policy-makers and society more widely Arguably the very exercise of drafting principles for care in these circumstances only makes that outcome more likely.

医疗保健和治疗空间的伦理影响
英国最近一则招聘护士在走廊进行护理的广告,重新引发了对与提供卫生保健的空间有关的伦理问题的讨论。可悲的是,至少在电视屏幕上,我们已经习惯了在战争和灾难的情况下——在极度匮乏的条件下——得到的治疗,但在相对富裕的国家,在和平时期,人们担心这种不太理想的护理情况会正常化。蕾切尔·巴里纳(Rachelle Barina)曾写过地方和空间之间的区别:“我说的地方是指提供医疗服务的物质质量、环境和地点。提供医疗保健的各个地方也是不同的空间。我所说的空间不仅指物理和地理特征,还指在这些地方形成、产生和发挥作用的思想、活动和符号。”老式南丁格尔病房安排和更亲密的设置之间的区别是一个熟悉的区别,但巴里纳也写了重症监护病房的属性,它不仅仅是特定的空间,而是围绕呼吸机的使用具有象征意义的空间。事实上,在2019冠状病毒病大流行期间,这一点非常明显。“走廊护理”或在被称为“临时升级空间”的空间进行护理显然不仅对患者有影响,而且对卫生保健提供者和更广泛的社会也有影响。至于病人,所提出的关切包括与隐私和尊严有关的问题(尽管必须承认,在标准病房中,使用窗帘可能提供视觉上的隐私,但不能提供语言上的隐私)。此外,在获取必要设备方面也存在问题。“走廊”这个词象征着一条通道,一个人可能想要进入的房间。正是在这些房间里,人们可以想象,所需的资源可能会被找到——但无法获得。对于卫生保健提供者来说,将自己的角色指定为“走廊护理人员”可能会降低工作满意度和挫折感,因为认识到自己没有必要的资金来提供自己想要的标准护理。Sheather和Phillips在回顾英国国家医疗服务体系(NHS England)发布的一份走廊护理伦理指南时指出,“安全、高质量的护理不能与走廊治疗共存”。这里的关键问题是正常化。“临时升级空间”何时成为永久功能?这是一个需要管理者、政策制定者和社会更广泛地考虑的问题,可以说,在这种情况下起草护理原则本身只会使这种结果更有可能出现。
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来源期刊
Bioethics
Bioethics 医学-医学:伦理
CiteScore
4.20
自引率
9.10%
发文量
127
审稿时长
6-12 weeks
期刊介绍: As medical technology continues to develop, the subject of bioethics has an ever increasing practical relevance for all those working in philosophy, medicine, law, sociology, public policy, education and related fields. Bioethics provides a forum for well-argued articles on the ethical questions raised by current issues such as: international collaborative clinical research in developing countries; public health; infectious disease; AIDS; managed care; genomics and stem cell research. These questions are considered in relation to concrete ethical, legal and policy problems, or in terms of the fundamental concepts, principles and theories used in discussions of such problems. Bioethics also features regular Background Briefings on important current debates in the field. These feature articles provide excellent material for bioethics scholars, teachers and students alike.
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