Division of Cardiology and Department of Bioethics and Humanities, University of Washington, Seattle, Washington.
Section of Cardiovascular Medicine, Program for Biomedical Ethics, Yale University, New Haven, Connecticut.
J Am Coll Cardiol. 2020 Jul 7;76(1):85-92. doi: 10.1016/j.jacc.2020.05.006. Epub 2020 May 11.
The COVID-19 pandemic and its sequelae have created scenarios of scarce medical resources, leading to the prospect that health care systems have faced or will face difficult decisions about triage, allocation, and reallocation. These decisions should be guided by ethical principles and values, should not be made before crisis standards have been declared by authorities, and, in most cases, will not be made by bedside clinicians. Do not attempt resuscitation and withholding and withdrawing decisions should be made according to standard determination of medical appropriateness and futility, but there are unique considerations during a pandemic. Transparent and clear communication is crucial, coupled with dedication to provide the best possible care to patients, including palliative care. As medical knowledge about COVID-19 grows, more will be known about prognostic factors that can guide these difficult decisions.
新冠疫情及其后遗症导致医疗资源短缺，这使得医疗体系面临或将要面临有关分诊、分配和再分配的艰难决策。这些决策应该遵循伦理原则和价值观，不应在当局宣布危机标准之前做出，而且在大多数情况下，也不应由床边临床医生做出。不应该进行复苏尝试，应该根据医疗适宜性和无效性的标准来做出保留和停止治疗的决策，但是在大流行期间需要考虑一些独特的因素。透明和清晰的沟通至关重要，同时还要致力于为患者提供尽可能好的护理，包括姑息治疗。随着对新冠病毒的医学知识不断增长，将会有更多关于可以指导这些艰难决策的预后因素的了解。
