Abstract
Background : While person- and patient-centered care aims to influence policymakers' rules and regulations to improve the care of individuals worldwide, there is a lack of exploration regarding this concept in the context of disasters and public health emergencies as an alternative ethical approach. The increase in the number and scale of disasters and public health emergencies globally has underscored the importance of effective management in these life-threatening situations. This study aims to provide a nuanced understanding among decision-makers, the public, and first responders of the advantages and challenges associated with diverse ethical approaches in emergencies to enhance patient care.
Approach : A survey, developed through several rounds of the Delphi methodology, consisted of 22 statements and was administered to 39 participants from nine different countries. The results of the questionnaire, along with participants' comments, were analyzed and published (Khorram-Manesh et al., 2024). Outcomes from the study were presented in a focus group interview with experts in disaster medicine, ethics, international law, and patient representatives. This section of the study focuses on the outcomes of the focus group. As a theoretical framework 3 different ethical approaches were used, the 1.industrial approach, or proceduralism, involves a process of "depersonalization," emphasizing mechanistic medicine. It also includes a 2.selective survival approach, which is rooted in consequentialist theory, favoring utilitarianism (the best outcome for the majority) over egalitarianism (equal distribution of health services to all in need). In contrast, 3.person-centered care prioritizes an individual's needs, preferences, and values in guiding clinical decisions.
Results: The results indicate that practitioners opted to utilize a combination of diverse ethical approaches when managing victims of disasters and public health emergencies.
Implications: The choice of approach is context- and situation-dependent and appears to primarily respond to the nature of the underlying etiology. This creates opportunities to employ various approaches to provide individualized care when flexible surge capacity is available.
Practice Implications: The findings of this study will contribute to future ethical discussions regarding person- and patient-centered care in situations with limited resources, helping to develop necessary ethical frameworks and educational guidelines.
Reference
1.Khorram-Manesh, A., Grey, L., Cocco, A-L., Ranse, J., Goniewic, K., Phattharapornjaroen, P., Nebil, A., Peyravi, M., Hertelendy, A., Kupietz, K., Bergholtz, J and Carlström, E. (2024), "Care in Emergencies and Disasters: Can it be Person-Centered?" Patient Education and Counseling. 118:108046. doi: 10.1016/j.pec.2023.108046.