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.

中文翻译：

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治疗感染患者的道德义务：原因的系统评价


在大流行期间，医疗保健提供者努力平衡对自己、家庭和患者的义务。虽然 HIV/AIDS 似乎解决了这个问题，但 2019 冠状病毒病 （COVID-19） 重新点燃了关于拒绝治疗的辩论。我们使用包括义务、拒绝、HIV/AIDS、COVID-19 和大流行病在内的术语检索了 MEDLINE、Embase、CINAHL Complete 和 Web of Science。在重复删除和双重独立筛选后，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 HIV/AIDS （72.2%）、严重急性呼吸系统综合症 （SARS） （10.2%）、COVID-19 （10.2%）、埃博拉病毒 （7.0%） 和流感 （7.0%）。大多数文章 （81.9%，n = 128） 表明有治疗义务。COVID-19 表明拒绝的伦理可接受性论文数量最高 （60%，P < .001），而 HIV 最少 （13.3%，P = .026）。在 COVID-19 期间，域存在显著差异的几个原因，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）。在 COVID-19 期间，伦理文献的激增倡导允许拒绝治疗。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。