Normative Analysis and Ethical Evaluation of Clinical Ethical Guidelines Published in the Context of Intensive Care Triage During Covid-19 Pandemic

Abstract

Throughout the COVID-19 pandemic, the rapid increase in the number of cases during certain periods has caused a high occupancy rate in intensive care units. Faced with a sudden and rapid increase in the number of patients, a lack of medical resources or its possibility led to ethical discussions on the immediate and equitable distribution of resources in intensive care units. This has not only given impetus to the ethical debate, but many medical professional organisations in Europe have published guidelines for triage of critical care which contain ethical criteria. In this study, some of the ethical triage guides have been normatively analyzed and ethically evaluated. Objective: The aim of this study is to identify and determine the parameters and normative concepts contained in the guidelines for triage published by the intensive care associations of Germany, Austria, Belgium, France, England, Switzerland and Italy. The results of this investigation were also critically and ethically evaluated and reflected. Materials and Methods: Critical normative analysis and ethical evaluation of clinical ethical guidelines published by intensive care and anaesthesia associations of the above-mentioned countries. Results: Although the studied triage guides used common parameters and similar normative concepts, there are significant differences between them. These differences were determined to be related to the triage criteria used, triage objectives, age factor, priority given to certain social groups and the application of different treatments to Covid-19 patients. Conclusion: Although the European countries that have published triage guides come from the same cultural tradition, the normative criteria and concepts they used in the triage guides are considered different values and priorities in their rankings. These differences may be due to the current political and ethical culture, also to the current economic and socio-cultural resources and their strategies for using their resources. Because of these facts and the reasons which we found, they should be considered in the preparation of ethical triage guidelines in Turkey.

Keywords

• Covid-19
• triage
• resource allocation
• ethical guidelines
• intensive care

Covid-19 Pandemisinde Yoğun Bakım Triyajı Bağlamında Hazırlanan Klinik Etik Rehberlerin Normatif Analizi ve Etik Değerlendirmesi

Abstract

Covid-19 Pandemisi sürecinde vaka sayılarının belli dönemlerde hızla yükselmesi yoğun bakım ünitelerinde yüksek doluluk oranlarına sebep olmuştur. Hasta sayısında yaşanan bu ani ve hızlı yükseliş karşısında tıbbi kaynakların yetersiz kalması ihtimali ve tecrübeleri yoğun bakım hizmetlerinde kaynakların acil ve adil dağıtımı ile ilgili etik tartışmaları başlatmıştır. Bu durum sadece etik tartışmalara ivme kazandırmakla kalmamış aynı zamanda Avrupa’daki birçok tıbbi meslek kuruluşu yoğun bakım triyajı için etik kriterler içeren rehberler yayınlamıştır. Bu çalışmada Avrupa’da yayınlanan bazı klinik-etik triyaj rehberleri normatif analize tabi tutularak etik açıdan değerlendirilmiştir. Amaç: Almanya, Avusturya, Belçika, Fransa, İngiltere, İsviçre ve İtalya’nın yoğun bakım derneklerinin triyaj için yayınlamış olduğu rehberlerin içerdikleri genel parametreleri ve normatif kavramları belirlemek ve bunların eleştirel bir değerlendirmesinden ortaya çıkan sonuçları tespit etmektir. Gereç ve Yöntem: Yukarıda adı geçen ülkelerin yoğun bakım ve anestezi derneklerinin Covid-19 pandemisi bağlamında yayınladıkları triyaj rehberlerinin eleştirel normatif analizi ve etik prensiplere göre değerlendirilmesi. Bulgular: İncelenen triyaj rehberleri ortak parametreler ve benzer normatif kavramlar kullanmış olmasına rağmen, birbirleri arasında önemli farklar bulunmaktadır. Bu farklılıkların kullanılan triyaj kriterleri, triyaj hedefleri, yaş faktörü, bazı sosyal gruplara öncelik verilmesi, ilk müdahale yapılması ve Covid-19 hastalarına farklı uygulama yapılması alanlarında olduğu tespit edilmiştir. Sonuç: Triyaj rehberlerini yayınlayan Avrupa ülkeleri aynı kültür geleneğinden gelse bile triyaj rehberlerinde kullandıkları kriterlere ve normatif kavramlara farklı değerler atfedilmiş ve farklı öncelikler verilmiştir. Bu farklılıkların oluşmasında güncel siyasi yaklaşımlar ve geçerli etik kültür etkili olabildiği gibi, o ülkenin hali hazırdaki maddi ve sosyo-kültürel kaynakları ve bu kaynakların kullanılmasındaki stratejileri de önemlidir. Bu bağlamda ülkemizde etik triyaj rehberlerine ihtiyaç duyulduğunda acilen hazırlanmalı ve hazırlanma sürecinde tüm bu noktalar göz önüne alınmalıdır.

Keywords

• Covid-19
• triyaj
• kısıtlı kaynakların adil dağıtımı
• etik rehberler
• yoğun bakım

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