Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
University of Turin, Department of Philosophy and Education Science, Torino, Italy.
J Med Ethics. 2020 Jun;46(6):364-366. doi: 10.1136/medethics-2020-106227. Epub 2020 Apr 9.
After initially emerging in China, the coronavirus (COVID-19) outbreak has advanced rapidly. The World Health Organization (WHO) has recently declared it a pandemic, with Europe becoming its new epicentre. Italy has so far been the most severely hit European country and demand for critical care in the northern region currently exceeds its supply. This raises significant ethical concerns, among which is the allocation of scarce resources. Professionals are considering the prioritisation of patients most likely to survive over those with remote chances, and this news has triggered an intense debate about the right of every individual to access healthcare. The proposed analysis suggests that the national emergency framework in which prioritisation criteria are currently enforced should not lead us to perceive scarce resources allocation as something new. From an ethical perspective, the novelty of the current emergency is not grounded in the devastating effects of scarce resources allocation, which is rife in recent and present clinical practice. Rather, it has to do with the extraordinarily high number of people who find themselves personally affected by the implications of scarce resources allocation and who suddenly realise that the principle of 'equals should be treated equally' may no longer be applicable. Along with the need to allocate appropriate additional financial resources to support the healthcare system, and thus to mitigate the scarcity of resources, the analysis insists on the relevance of a medical ethics perspective that does not place the burden of care and choice solely on physicians.
冠状病毒(COVID-19)疫情最初在中国出现后迅速蔓延。世界卫生组织(WHO)最近宣布其为大流行,欧洲已成为其新的中心。意大利目前是受影响最严重的欧洲国家,北部地区对重症监护的需求超过了供应。这引发了重大的伦理问题,其中包括稀缺资源的分配。专业人员正在考虑优先考虑最有可能存活的患者,而这一消息引发了关于每个人都有权获得医疗保健的激烈辩论。提出的分析表明,目前实施优先排序标准的国家紧急框架不应使我们将稀缺资源分配视为新事物。从伦理角度来看,目前紧急情况的新颖之处不在于稀缺资源分配的破坏性影响,因为这种影响在最近和当前的临床实践中普遍存在。相反,它与大量个人受到稀缺资源分配影响的人数有关,这些人突然意识到“平等者应该平等对待”的原则可能不再适用。除了需要分配适当的额外财政资源来支持医疗保健系统,从而缓解资源短缺之外,该分析还坚持认为需要采取一种医学伦理观点,这种观点不应将护理和选择的负担完全放在医生身上。