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首页> 外文期刊>Journal of International Humanitarian Action >Moral experiences of humanitarian health professionals caring for patients who are dying or likely to die in a humanitarian crisis
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Moral experiences of humanitarian health professionals caring for patients who are dying or likely to die in a humanitarian crisis

机译：人道主义卫生专业人员照顾在人道主义危机中死亡或可能死亡的患者的道德经历

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Abstract Wars, disasters, and epidemics affect millions of individuals every year. International non-governmental organizations respond to many of these crises and provide healthcare in settings ranging from a field hospital deployed after an earthquake, to a health clinic in a longstanding refugee camp, to a treatment center during an infectious disease outbreak. The primary focus of these activities is to save lives. However, inevitably, many patients cannot be saved. We undertook an interpretive description study to investigate humanitarian policy-maker and care providers’ experiences and perceptions of palliative care during humanitarian crises. In this paper, we report on interviews with 23 health professionals, 11 of whom also had experience as policy-makers within a humanitarian organization. We use the concept of moral experience as an analytic lens: participants’ experiences of values that they held to be important being realized or thwarted as they responded to the needs of patients who were dying or likely to die.We identified five themes related to participants’ moral experiences, all of which relate to values of compassion in the provision of care, and justice in accessing it. (1) Participants described intervening to ease the suffering of dying patients as an inherent aspect of humanitarianism and their duty as health professionals. (2) Participants also expressed that upholding dignity was of critical importance, stemming from a recognition of shared humanity and as an act of respect. (3) Since humanitarian action is provided in situations of scarcity, prioritization is inescapable. Acknowledging the primacy of curative care in emergencies, participants also emphasized the importance of ensuring that care for the dying was attended to, including during triage. (4) Participants reported working within and pushing against systemic constraints such as legal or logistical barriers to opioids, lack of guidelines, and conflicting views with colleagues. (5) Given the stakes involved, participants felt a heavy weight of responsibility and described their challenges in carrying it.These findings illuminate experiences responding to patients who are dying or likely to die, and how these connect with the values of humanitarian health professionals, sometimes resulting in dissonance between values and actions. They also point to the need to make more space for palliative, alongside curative, approaches to care in situations of humanitarian crises, ideally by further integrating them.
机译：摘要战争，灾难和流行病每年影响数百万人。国际非政府组织应对许多此类危机，并在各种环境中提供医疗服务，包括地震后部署的野战医院，长期存在的难民营中的医疗所以及传染病暴发期间的治疗中心。这些活动的主要重点是挽救生命。但是，不可避免地，许多患者无法得救。我们进行了一项解释性描述研究，以调查人道主义政策制定者和护理提供者在人道主义危机期间对姑息治疗的经验和看法。在本文中，我们报告了对23位卫生专业人员的采访，其中11位也曾在人道主义组织中担任过政策制定者。我们将道德体验的概念用作分析的视角：参与者对死亡或可能死亡患者的需求做出回应时，他们认为很重要的价值观经历被实现或挫败了。我们确定了与参与者相关的五个主题的道德经历，所有这些都与提供护理方面的同情价值以及获得护理方面的正义有关。 （1）与会者认为，为减轻垂死的患者的痛苦而进行的干预是人道主义的内在方面，也是其作为卫生专业人员的职责。 （2）与会者还表示，维护尊严至关重要，这源于对共同人类的认可和尊重。 （3）由于在稀缺情况下采取了人道主义行动，因此无法确定优先次序。参加者认识到紧急情况下的治疗至关重要，并强调必须确保对临终者的护理，包括分诊时的护理。 （4）参与者报告说，他们正在努力并努力制止系统性的限制，例如对阿片类药物的法律或后勤障碍，缺乏指导方针以及与同事的观点不一致。 （5）考虑到所涉及的利益攸关方，参与者感到责任重大，并描述了承担责任的挑战。这些发现阐明了对垂死或可能死亡患者的反应经验，以及这些经验如何与人道主义卫生专业人员的价值观联系起来，有时会导致价值观与行动之间的不和谐。他们还指出，有必要为人道主义危机情况下的姑息治疗和治疗方法提供更多空间，最好是进一步整合这些方法。

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