Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024
The Ethical Obligation to Treat Infectious Patients: A Systematic Review of Reasons.
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Grisel Braylee, Kaur Kavneet, Swain Sonal, Gorenshtein Laura, Chime Chinecherem, O'Callaghan Ellen, Vasireddy Avani, Moore Lauren, Shin Christina, Won Michelle, Ebangwese Santita, Tripoli Todd, Lumpkin Stephanie, Ginsberg Zachary, Cantrell Sarah, Freeman Jennifer, Agarwal Suresh, Haines Krista
Аннотация
During pandemics, healthcare providers struggle with balancing obligations to self, family, and patients. While HIV/AIDS seemed to settle this issue, coronavirus disease 2019 (COVID-19) rekindled debates regarding treatment refusal. We searched MEDLINE, Embase, CINAHL Complete, and Web of Science using terms including obligation, refusal, HIV/AIDS, COVID-19, and pandemics. After duplicate removal and dual, independent screening, we analyzed 156 articles for quality, ethical position, reasons, and concepts. Diseases in our sample included HIV/AIDS (72.2%), severe acute respiratory syndrome (SARS) (10.2%), COVID-19 (10.2%), Ebola (7.0%), and influenza (7.0%). Most articles (81.9%, n = 128) indicated an obligation to treat. COVID-19 had the highest number of papers indicating ethical acceptability of refusal (60%, P < .001), while HIV had the least (13.3%, P = .026). Several reason domains were significantly different during COVID-19, including unreasonable risks to self/family (26.7%, P < .001) and labor rights/workers' protection (40%, P < .001). A surge in ethics literature during COVID-19 has advocated for permissibility of treatment refusal. Balancing healthcare provision with workforce protection is crucial in effectively responding to a global pandemic.