Abstracts
Abstract
The complex health and social circumstances of living-at-risk, frequent users of emergency departments (aREDFUs) in the health jurisdictions of high-income countries, and the related, significant challenges posed for emergency departments and the health care providers working within them, are identified and explored in the paper. Ethical analyses of a set of relevant domains are performed, i.e., individual and relational autonomy considerations, relevant social construction and personal responsibility conceptions, patient welfare principles (beneficence, nonmaleficence, continuity of care), harm reduction methodologies and their applications, health equity, and justice considerations of the distributive, formal and social types. The outcomes of these analyses demonstrate that there are ethically compelling reasons for emergency departments to adopt an ethics-informed, policy-based approach to the longitudinal care and management of living-at-risk, frequent users of emergency departments. From a formal justice perspective, the development and uses of such an approach are justified by a demonstrable relevant difference between living-at-risk, frequent users of emergency departments and other persons and groups of patients who visit emergency departments. We propose an example of such a policy-based approach. Examples of possible, pragmatic applications of this approach, which help ensure that aREDFUs who present to the ED are managed in a fair and optimally consistent manner, are provided for the consideration of an urban emergency department’s policymaking working group.
Keywords:
- living-at-risk,
- frequent users,
- emergency departments,
- individual and relational autonomy,
- social construction,
- personal responsibility,
- social justice,
- health equity,
- harm reduction
Résumé
L’article identifie et explore les circonstances sanitaires et sociales complexes des personnes à risque qui fréquentent les services d’urgence dans les juridictions sanitaires des pays à revenu élevé, ainsi que les défis importants qui en découlent pour les services d’urgence et les prestataires de soins de santé qui y travaillent. Des analyses éthiques d’un ensemble de domaines pertinents sont effectuées, à savoir les considérations d’autonomie individuelle et relationnelle, les conceptions pertinentes de construction sociale et de responsabilité personnelle, les principes de bien-être du patient (bienfaisance, non-malfaisance, continuité des soins), les méthodologies de réduction des risques et leurs applications, l’équité en santé et les considérations de justice de type distributif, formel et social. Les résultats de ces analyses démontrent qu’il existe des raisons éthiques impérieuses pour que les services d’urgence adoptent une approche fondée sur l’éthique et les politiques en matière de soins longitudinaux et de gestion des personnes à risque qui fréquentent fréquemment les services d’urgence. Du point de vue de la justice formelle, le développement et l’utilisation d’une telle approche sont justifiés par une différence pertinente démontrable entre les utilisateurs fréquents à risque des services d’urgence et les autres personnes et groupes de patients qui visitent les services d’urgence. Des exemples d’applications pragmatiques possibles de cette approche, qui contribuent à garantir que les personnes à risque qui se présentent aux urgences sont prises en charge de manière équitable et parfaitement cohérente, sont soumis à l’examen du groupe de travail chargé de l’élaboration des politiques dans un service d’urgence urbain.
Mots-clés :
- vivre à risque,
- utilisateurs fréquents,
- services d’urgence,
- autonomie individuelle et relationnelle,
- construction sociale,
- responsabilité personnelle,
- justice sociale,
- équité en santé,
- réduction des méfaits
Appendices
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