University of Pennsylvania.
University of Pittsburgh Medical Center.
Am J Bioeth. 2020 Jul;20(7):28-36. doi: 10.1080/15265161.2020.1764141. Epub 2020 May 18.
During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift-to some degree-from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by "crisis standards of care," but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities.
在包括 COVID-19 大流行在内的公共卫生危机期间，资源短缺和传染风险可能要求卫生系统在一定程度上从以关注个体患者福祉为重点的常规临床伦理转向以关注人群健康为重点的公共卫生伦理。存在许多属于“危机护理标准”所提供的法律保护范围内的分诊政策，但它们有关键的区别。我们从伦理、法律、残疾和实施的角度批判性地评估了政策之间最根本的区别之一，即使用标准将某些患者从原本标准的医疗服务中排除在外。我们从伦理、法律、残疾和实施的角度来审视这些分类排除标准。我们的分析集中在最常见的排除标准上，即针对特定疾病的排除标准，我们得出结论，用于重症监护资源分配和心肺复苏（CPR）使用的最佳政策不应该使用分类排除。我们认为，避免分类排除在实践中通常是可行的，符合公共卫生规范，并减轻了对残疾人士的歧视。
