Department of Emergency Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
Prehosp Disaster Med. 2009 May-Jun;24(3):215-21. doi: 10.1017/s1049023x0000683x.
In an epidemic situation or large-scale disaster, medical and human resources may be stretched to the point of exhaustion. Appropriate planning must incorporate plans of action that minimize public health morbidity and mortality while maximizing the appropriate use of medical and human healthcare resources. While the current novel H1N1 influenza has spread throughout the world, the severity of this strain of influenza appears to be relatively less virulent and lethal compared to the 1918 influenza pandemic. However, the presence of this new influenza strain has reignited interest in pandemic planning. Amongst other necessary resources needed to combat pandemic influenza, a major medical resource concern is the limited number of mechanical ventilators that would be available to be used to treat ill patients. Recent reported cases of avian influenza suggest that mechanical ventilation will be required for the successful recovery of many individuals ill with this strain of virus. However, should the need for ventilators exceed the number of available machines, how will care providers make the difficult ethical decisions as to who should be placed or who should remain on these machines as more influenza patients arrive in need of care? This paper presents a decision-making model for clinicians that is based upon the bioethical principles of beneficence and justice. The model begins with the basic assumptions of triage and progresses into a useful algorithm based upon utilitarian principles. The model is intended to be used as a guide for clinicians in making decisions about the allocation of scarce resources in a just manner and to serve as an impetus for institutions to create or adapt plans to address resource allocation issues should the need arise.
在疫情或大规模灾害中，医疗和人力资源可能会被耗尽。适当的规划必须包含行动方案，使公共卫生发病率和死亡率降至最低，同时最大限度地合理利用医疗和人力资源。虽然目前的新型 H1N1 流感已在全球范围内传播，但这种流感株的严重程度似乎相对不那么致命和致命，与 1918 年流感大流行相比。然而，这种新流感株的出现再次引发了对大流行规划的兴趣。在抗击大流行性流感所需的其他必要资源中，一个主要的医疗资源问题是可用于治疗患病患者的机械呼吸机数量有限。最近报告的禽流感病例表明，许多患有这种病毒的人需要机械通气才能成功康复。然而，如果需要呼吸机的人数超过可用机器的数量，护理提供者将如何做出艰难的伦理决策，即应该将谁安置或谁应该留在这些机器上，因为有更多的流感患者需要护理？本文提出了一种基于效益和公正的生物伦理原则的临床医生决策模型。该模型从分类的基本假设开始，并根据功利主义原则发展成为一种有用的算法。该模型旨在作为临床医生在以公正的方式分配稀缺资源方面做出决策的指南，并作为机构制定或适应计划以解决资源分配问题的动力，如果需要的话。
