CHEST Guidelines-Ethical-Considerations

Ethical-Considerations_chest

Pdf Summary

The CHEST Consensus Statement provides ethical guidance for the care of critically ill and injured patients during pandemics and disasters. Recognizing the unique challenges these situations present, the statement offers suggestions in five domains: triage and allocation, patient and family ethical concerns, provider responsibilities, research conduct, and international disaster response.<br /><br />The methodology involved adapting the CHEST Guidelines Oversight Committee's methods, developing key questions, conducting literature searches, and using a modified Delphi process for developing expert opinion-based suggestions. The ethical challenges include fair allocation of scarce resources, balancing patient autonomy, beneficence, and justice, and providing consistent care under crisis conditions.<br /><br />For triage and allocation, it is suggested that resources not be withheld once a mass disaster protocol is in effect, and that triage systems based on evidence are preferable to those based on clinical judgment alone. It is also suggested that specific critical care resources be allocated based on objective criteria and that certain intensive therapies might be limited during disasters.<br /><br />In addressing patient and family concerns, hospitals are encouraged to communicate crisis care standards clearly and offer support through palliative care resources. Provider responsibilities include managing moral distress and ensuring safety, with plans in place for non-clinical roles for clinicians who object to crisis standard implementation.<br /><br />Research during disasters should be ethically justified, focusing on improving treatment and outcomes, with collaborations recommended for pre-disaster IRB approvals.<br /><br />International responses should align with local norms to offer sustainable benefits and respect cultural practices. Overall, the statement emphasizes the necessity of ethical preparedness to guide decision-making during public health emergencies and suggests ongoing dialogue and research to refine these guidelines.

Keywords

ethical guidance

critically ill

pandemics

disasters

triage

resource allocation

patient autonomy

moral distress

international response

public health emergencies