Abstract：
During pandemics, healthcare providers struggle with balancing obligations to self, family, and patients. While HIV/AIDS seemed to settle this issue, coronavirus disease 2019 (COVID-19) rekindled debates regarding treatment refusal. We searched MEDLINE, Embase, CINAHL Complete, and Web of Science using terms including obligation, refusal, HIV/AIDS, COVID-19, and pandemics. After duplicate removal and dual, independent screening, we analyzed 156 articles for quality, ethical position, reasons, and concepts. Diseases in our sample included HIV/AIDS (72.2%), severe acute respiratory syndrome (SARS) (10.2%), COVID-19 (10.2%), Ebola (7.0%), and influenza (7.0%). Most articles (81.9%, n = 128) indicated an obligation to treat. COVID-19 had the highest number of papers indicating ethical acceptability of refusal (60%, P < .001), while HIV had the least (13.3%, P = .026). Several reason domains were significantly different during COVID-19, including unreasonable risks to self/family (26.7%, P < .001) and labor rights/workers\' protection (40%, P < .001). A surge in ethics literature during COVID-19 has advocated for permissibility of treatment refusal. Balancing healthcare provision with workforce protection is crucial in effectively responding to a global pandemic.
摘要：
在大流行期间，医疗保健提供者努力平衡对自我的义务，家庭,和病人。虽然艾滋病毒/艾滋病似乎解决了这个问题，2019年冠状病毒病（COVID-19）重新点燃了关于拒绝治疗的辩论。我们搜索了MEDLINE,Embase,CINAHL完成,和WebofScience使用包括义务在内的术语，拒绝,艾滋病毒/艾滋病，新冠肺炎和流行病。重复删除和双重删除后，独立筛查,我们分析了156篇文章的质量，道德立场，原因,和概念。我们样本中的疾病包括艾滋病毒/艾滋病(72.2%)，严重急性呼吸系统综合症（SARS）（10.2％），COVID-19（10.2%），埃博拉（7.0%），和流感(7.0%)。大多数文章（81.9%，n=128)表示有义务治疗。COVID-19的论文数量最多，表明拒绝的道德可接受性(60%，P<.001),而艾滋病毒感染最少(13.3%，P=.026）。在COVID-19期间，几个原因领域显着不同，包括对自我/家庭的不合理风险(26.7%，P<.001)和劳工权利/工人保护(40%，P<.001)。COVID-19期间伦理文献的激增主张允许拒绝治疗。平衡医疗保健供应与劳动力保护对于有效应对全球大流行至关重要。
