Neves Nedy M B C, Bitencourt Flávia B C S N, Bitencourt Almir G V
. Universidade Salvador (Unifacs), Salvador, BA, Brasil.
. Fleury Medicina e Saúde, São Paulo, SP, Brasil.
Rev Assoc Med Bras (1992). 2020 Sep 21;66Suppl 2(Suppl 2):106-111. doi: 10.1590/1806-9282.66.S2.106. eCollection 2020.
The respiratory disease caused by the coronavirus SARS-CoV-2 (COVID-19) is a pandemic that produces a large number of simultaneous patients with severe symptoms and in need of special hospital care, overloading the infrastructure of health services. All of these demands generate the need to ration equipment and interventions. Faced with this imbalance, how, when, and who decides, there is the impact of the stressful systems of professionals who are at the front line of care and, in the background, issues inherent to human subjectivity. Along this path, the idea of using artificial intelligence algorithms to replace health professionals in the decision-making process also arises. In this context, there is the ethical question of how to manage the demands produced by the pandemic. The objective of this work is to reflect, from the point of view of medical ethics, on the basic principles of the choices made by the health teams, during the COVID-19 pandemic, whose resources are scarce and decisions cause anguish and restlessness. The ethical values for the rationing of health resources in an epidemic must converge to some proposals based on fundamental values such as maximizing the benefits produced by scarce resources, treating people equally, promoting and recommending instrumental values, giving priority to critical situations. Naturally, different judgments will occur in different circumstances, but transparency is essential to ensure public trust. In this way, it is possible to develop prioritization guidelines using well-defined values and ethical recommendations to achieve fair resource allocation.
由冠状病毒SARS-CoV-2引起的呼吸系统疾病（COVID-19）是一场大流行病，它导致大量患者同时出现严重症状，需要特殊的医院护理，使卫生服务基础设施不堪重负。所有这些需求使得有必要对设备和干预措施进行配给。面对这种失衡，如何、何时以及由谁来做出决定，这涉及到处于护理一线的专业人员所面临的压力系统的影响，以及背后人类主观性所固有的问题。沿着这条道路，还出现了使用人工智能算法在决策过程中取代卫生专业人员的想法。在这种背景下，存在着如何应对大流行病所产生需求的伦理问题。这项工作的目的是从医学伦理的角度，反思在COVID-19大流行期间，卫生团队做出选择的基本原则，当时资源稀缺，决策引发痛苦和不安。在流行病中对卫生资源进行配给的伦理价值观必须汇聚到一些基于基本价值观的提议上，比如使稀缺资源产生的效益最大化、平等对待人们、促进和推荐工具性价值观、优先处理危急情况。当然，在不同情况下会有不同的判断，但透明度对于确保公众信任至关重要。通过这种方式，有可能利用明确界定的价值观和伦理建议制定优先排序指南，以实现公平的资源分配。
