ETHICAL APPROACHES IN PRE-HOSPITAL FIELD TRIAGE

Year 2020, Volume: 5 Issue: 1, 57 - 66, 03.04.2020

Hasan Erbay

Abstract

The theoretical ethical foundations of pre-hospital emergency healthcare systems are based on the principle of "beneficence" from the basic principles of medical ethics. The strongest criticism of triage practices is that the principle of "justice" is not taken into account. The “distributive justice” dimension of the principle of justice is in the focus of ethical discussions. Triage recommended to be applied in cases where resources are limited and the number of injured is high; it contains many ethical conflicts and it is difficult to justify cases. As soon as the necessary conditions are met, the triage must immediately be abandoned. In the prehospital triage; in addition to ethical approaches such as “beneficence/utilitarianism”, “justice”, “equality” and “equity”, there are also a variety of algorithms that derived from principles and values of different philosophical thoughts. In this study, the approaches related to pre-hospital triage are examined and the subject is interpreted in the context of medical ethics.

Keywords

Pre-hospital Emergency Medicine, Triage, Ethics, Decision-making, Beneficence, Justice

HASTANE ÖNCESİ ALAN TRİYAJINDA ETİK YAKLAŞIMLAR

Abstract

Hastane öncesi acil sağlık sistemlerinin, ilkesel bağlamdaki kuramsal etik temelleri, temel tıp etiği ilkelerinden “faydacılık” ilkesi üzerine kuruludur. Triyaj uygulamalarına yöneltilen en güçlü eleştiri, “adalet” ilkesinin dikkate alınmadığı ile ilgilidir. Adalet ilkesinin ise özellikle “dağıtıcı adalet” boyutu etik tartışmaların odağındadır. Kaynakların kısıtlı ve yaralıların fazla olduğu durumlarda uygulanması önerilen triyaj; etik açıdan pek çok sorun içermekte ve gerekçelendirilmesi zor, savunulması güç durumlara neden olabilmektedir. Gerekli şartlar sağlandığı an triyaj uygulamasından derhal vazgeçilmelidir. Hastane öncesi alan triyajında; “yarar sağlama/faydacılık”, “adalet”, “eşitlik” ve “adil olma” gibi etik yaklaşımların yanında, farklı felsefi akımlardan beslenen ilkeler ve değerler ile kaynağını bu etik kuramlardan alan çok çeşitli algoritmalar da mevcuttur. Bu çalışmada, hastane öncesi alan triyajıyla ilgili yaklaşımları incelenmiş ve konu tıp etiği bağlamında yorumlanmıştır.

Keywords

Hastane Öncesi Acil Tıp, Triyaj, Etik, Karar Verme, Yarar Sağalama, Adalet

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