Етичний компас медичних рішень під час пандемії COVID-19

Abstract

The article actualizes and structures significant problems of the medical sphere that arise in the context of the COVID-19 pandemic, in terms of the relations vectors: global world – state – person, state – clinic – society, clinic – doctor (medical staff), clinic – patient, doctor (medical staff) – the patient. The authors presented the evolutionary context of the norming process of medical resources and emphasized the hierarchical scheme of the regulation process of scarce resources norming in the health care system under the pandemic crisis conditions. The paper substantiates approaches to making medical decisions on “sorting” and applying a number of its forms depending on various regional, national, religious, and local models of the ethical values system formation. Emphasis is placed on American and European models of bioethics. The authors consider the utilitarian approach to preparing medical solutions of “clinical sorting” to level ethical catastrophes in a pandemic based on Catholic ethics. The issues of regulated norming of scarce medical resources and the “clinical triage” of patients during the COVID-19 pandemic in Ukraine have been investigated. The main bioethical dilemma of the COVID-19 pandemic is outlined. The authors actualize criteria and models of ethical medical solutions for equitable allocation of scarce medical resources in the context of the COVID-19 pandemic. These criteria and models are defined in the Ethical Guidelines for Responding to COVID-19 of the Bioethics Committee at the Council of Europe, the US Department of Health and Human Services; in normative documents in the field of ethics of medical decisions during the COVID-19 pandemic of the National Medical Associations, chambers, centres of bioethics of Italy, Hungary, USA, Great Britain; in the guidelines of national, religious and local institutions for the preparation of medical decisions for the levelling ethical catastrophes during the pandemic and the studies of international bioethics experts. The paper identified the need to formalize the fair distribution of scarce resources during the COVID-19 pandemic in Ukraine. The authors suggested recommendations for the implementation of ethical values and priorities for their application in critical conditions of shortage of medical resources and personnel in the COVID-19 pandemic in the health care system of Ukraine.