[Medical decision-making in clinical disaster medicine and in healthcare crises : Applying ethics and law in resource allocation].

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2025-09-01 Epub Date: 2025-08-05 DOI:10.1007/s00113-025-01614-6
Axel R Heller, Thomas Wurmb, Axel Franke
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Abstract

In health crises marked by severe resource scarcity, such as during the COVID-19 pandemic and in anticipated scenarios of national or state defence, hospitals face the challenge of maintaining the best possible medical care under ethically and legally responsible conditions. This article analyzes the ethical, legal and operational foundations of resource allocation in clinical disaster medicine. Central to this are the principles of utility maximization, fairness and transparency, which necessitate a shift from standard individual-centered care to a population-oriented crisis response. Medical indication forms the cornerstone of any treatment and must be evidence-based and patient-centered, even under crisis conditions. Therapeutic goals and prognostic assessment within the given resource constraints serve as key criteria for prioritization and allocation decisions. The use of triage category IV (blue) and the implementation of tertiary (ex-post) triage within hospitals are only conceivable under conditions of existential scarcity and require clear legal and ethical justification. Clinical ethics committees and independent triage teams play a pivotal role in decision-making and communication. The legal interpretation, particularly in the context of § 5c of the German Infection Protection Act, remains controversial and demands nuanced evaluation. The article underlines the necessity of consistent decision-making processes, structured documentation and the inclusion of vulnerable populations in crisis planning. Finally, operational strategies, such as tactical abbreviated surgical care (TASC), are presented as resource-efficient approaches to care. The overarching goal is to enable as many patients as possible to access the best achievable medical care, even under extreme conditions, while upholding ethical standards.

临床灾难医学和医疗危机中的医疗决策:在资源配置中的伦理和法律应用
在以资源严重短缺为特征的卫生危机中,例如在2019冠状病毒病大流行期间以及在预计的国家或国家防御情景中,医院面临着在道德和法律上负责任的条件下保持尽可能最好的医疗服务的挑战。本文分析了临床灾害医学资源配置的伦理、法律和操作基础。这方面的核心是效用最大化、公平和透明原则,这就需要从标准的以个人为中心的护理转变为以人口为中心的危机应对。医学指征是任何治疗的基石,必须以证据为基础,以患者为中心,即使在危机情况下也是如此。在给定资源限制下的治疗目标和预后评估是确定优先级和分配决策的关键标准。只有在存在匮乏的条件下,才能在医院内使用第四类(蓝色)分诊和实施第三类(事后)分诊,并需要明确的法律和道德理由。临床伦理委员会和独立的分诊小组在决策和沟通中发挥着关键作用。法律解释,特别是在德国感染保护法§5c的背景下,仍然存在争议,需要进行细致的评估。这篇文章强调了一致的决策过程、结构化的文件和将弱势群体纳入危机规划的必要性。最后,操作策略,如战术简略手术护理(TASC),提出了资源高效的护理方法。总体目标是使尽可能多的患者即使在极端条件下也能获得最好的医疗服务,同时坚持道德标准。
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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