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Abstract：
UNASSIGNED: The coronavirus disease 2019 (COVID-19) pandemic has raised a variety of ethical dilemmas for health care providers. Limited data are available on how a patient\'s concomitant cancer diagnosis affected ethical concerns raised during the early stages of the pandemic.
UNASSIGNED: We performed a retrospective review of all COVID-related ethics consultations registered in a prospectively collected ethics database at a tertiary cancer center between March 14, 2020, and April 28, 2020. Primary and secondary ethical issues, as well as important contextual factors, were identified.
UNASSIGNED: Twenty-six clinical ethics consultations were performed on 24 patients with cancer (58.3% male; median age, 65.5 years). The most common primary ethical issues were code status (n = 11), obligation to provide nonbeneficial treatment (n = 3), patient autonomy (n = 3), resource allocation (n = 3), and delivery of care wherein the risk to staff might outweigh the potential benefit to the patient (n = 3). An additional nine consultations raised concerns about staff safety in the context of likely nonbeneficial treatment as a secondary issue. Unique contextual issues identified included concerns about public safety for patients requesting discharge against medical advice (n = 3) and difficulties around decision making, especially with regard to code status because of an inability to reach surrogates (n = 3).
UNASSIGNED: During the early pandemic, the care of patients with cancer and COVID-19 spurred a number of ethics consultations, which were largely focused on code status. Most cases also raised concerns about staff safety in the context of limited benefit to patients, a highly unusual scenario at our institution that may have been triggered by critical supply shortages.
UNASSIGNED: We performed a retrospective review of all COVID-related ethics consultations registered in a prospectively collected ethics database at a tertiary cancer center between March 14, 2020, and April 28, 2020. Primary and secondary ethical issues, as well as important contextual factors, were identified.
UNASSIGNED: Twenty-six clinical ethics consultations were performed on 24 patients with cancer (58.3% male; median age, 65.5 years). The most common primary ethical issues were code status (n = 11), obligation to provide nonbeneficial treatment (n = 3), patient autonomy (n = 3), resource allocation (n = 3), and delivery of care wherein the risk to staff might outweigh the potential benefit to the patient (n = 3). An additional nine consultations raised concerns about staff safety in the context of likely nonbeneficial treatment as a secondary issue. Unique contextual issues identified included concerns about public safety for patients requesting discharge against medical advice (n = 3) and difficulties around decision making, especially with regard to code status because of an inability to reach surrogates (n = 3).
UNASSIGNED: During the early pandemic, the care of patients with cancer and COVID-19 spurred a number of ethics consultations, which were largely focused on code status. Most cases also raised concerns about staff safety in the context of limited benefit to patients, a highly unusual scenario at our institution that may have been triggered by critical supply shortages.
摘要：
■2019年冠状病毒病（COVID-19）大流行给医疗保健提供者带来了各种道德困境。关于患者的伴随癌症诊断如何影响大流行早期提出的伦理问题的数据有限。
我们对2020年3月14日至2020年4月28日在三级癌症中心前瞻性收集的伦理数据库中注册的所有与COVID相关的伦理咨询进行了回顾性审查。主要和次要的道德问题，以及重要的环境因素，已确定。
■对24例癌症患者进行了26次临床伦理咨询（58.3％为男性；中位年龄，65.5年）。最常见的主要道德问题是代码状态(n=11)，提供非有益治疗的义务(n=3)，患者自主性（n=3），资源分配(n=3)，和提供护理，其中对工作人员的风险可能超过对患者的潜在益处（n=3）。另外9次咨询引起了人们对工作人员安全的担忧，因为这可能是次要问题。确定的独特背景问题包括对要求出院的患者的公共安全的担忧（n=3）以及决策方面的困难，特别是关于代码状态，因为无法达到代理人(n=3)。
■在早期大流行期间，癌症患者和COVID-19的护理引发了许多伦理咨询，主要集中在代码状态上。大多数病例还在患者受益有限的情况下引起了对工作人员安全的担忧，我们机构的一个非常不寻常的情况，可能是由严重的供应短缺引发的。
我们对2020年3月14日至2020年4月28日在三级癌症中心前瞻性收集的伦理数据库中注册的所有与COVID相关的伦理咨询进行了回顾性审查。主要和次要的道德问题，以及重要的环境因素，已确定。
■对24例癌症患者进行了26次临床伦理咨询（58.3％为男性；中位年龄，65.5年）。最常见的主要道德问题是代码状态(n=11)，提供非有益治疗的义务(n=3)，患者自主性（n=3），资源分配(n=3)，和提供护理，其中对工作人员的风险可能超过对患者的潜在益处（n=3）。另外9次咨询引起了人们对工作人员安全的担忧，因为这可能是次要问题。确定的独特背景问题包括对要求出院的患者的公共安全的担忧（n=3）以及决策方面的困难，特别是关于代码状态，因为无法达到代理人(n=3)。
■在早期大流行期间，癌症患者和COVID-19的护理引发了许多伦理咨询，主要集中在代码状态上。大多数病例还在患者受益有限的情况下引起了对工作人员安全的担忧，我们机构的一个非常不寻常的情况，可能是由严重的供应短缺引发的。
