Department of Medical Genetics, University of British Columbia, British Columbia, Canada.
Mazankowski Alberta Hearth Institute, Division of Cardiac Surgery, Departments of Critical Care Medicine and Surgery, University of Alberta, Edmonton, Alberta, Canada.
Can J Cardiol. 2020 Aug;36(8):1313-1316. doi: 10.1016/j.cjca.2020.06.002. Epub 2020 Jun 4.
The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined. The prioritisation model may be used to determine how and when cardiovascular services should be continued or restored. There should be a focus on an iterative and responsive approach to broader health care system needs, such as other disease groups and local outbreaks.
新冠疫情给心血管疾病领域的领导者和从业者带来了伦理问题。人们的注意力已经从关注个体患者获益的体系，转移到了关注保护整个社会的体系。具有挑战性的资源分配问题突显了制定明确的伦理框架的必要性，该框架将有原则的决策纳入不同心血管护理服务的优先级排序过程中。本文提供了危害最小化、公平、相称性、尊重、互惠、灵活性和程序正义等原则的实际应用，并概述了心血管服务恢复的优先级排序模型。该优先级排序模型可用于确定应如何以及何时继续或恢复心血管服务。应该关注更广泛的医疗体系需求，例如其他疾病群体和当地疫情，采用迭代和响应的方法。
