Providence Health Care, Vancouver, Canada.
Division of Geriatric Medicine, University of British Columbia, Vancouver, Canada.
J Am Geriatr Soc. 2020 Aug;68(8):1666-1670. doi: 10.1111/jgs.16666. Epub 2020 Jul 4.
During the coronavirus disease 2019 (COVID-19) pandemic, principles from both clinical and public health ethics cue clinicians and healthcare administrators to plan alternatives for frail older adults who prefer to avoid critical care, and for when critical care is not available due to crisis triaging. This article will explore the COVID-19 Ethical Decision Making Framework, published in British Columbia (BC), Canada, to familiarize clinicians and policy makers with how ethical principles can guide systems change, in the service of frail older adults. In BC, the healthcare system has launched resources to support clinicians in proactive advance care planning discussions, and is providing enhanced supportive and palliative care options to residents of long-term care facilities. If the pandemic truly overwhelms the healthcare system, frailty, but not age alone, provides a fair and evidence-based means of triaging patients for critical care and could be included into ventilator allocation frameworks. J Am Geriatr Soc 68:1666-1670, 2020.
在 2019 年冠状病毒病（COVID-19）大流行期间，临床和公共卫生伦理学的原则提示临床医生和医疗保健管理人员为那些宁愿避免重症监护的体弱老年人以及因危机分诊而无法获得重症监护的老年人制定替代方案。本文将探讨加拿大不列颠哥伦比亚省（BC）发布的 COVID-19 伦理决策框架，以使临床医生和政策制定者熟悉如何利用伦理原则指导系统变革，以服务于体弱老年人。在 BC，医疗保健系统已经推出了资源，以支持临床医生进行积极的预先护理计划讨论，并为长期护理设施的居民提供增强的支持性和姑息性护理选择。如果大流行真的使医疗系统不堪重负，那么脆弱性而不仅仅是年龄，为对重症监护患者进行分诊提供了公平和基于证据的手段，并且可以纳入呼吸机分配框架。J Am Geriatr Soc 68:1666-1670, 2020。
