Verweij Marcel, van de Vathorst Suzanne, Schermer Maartje, Willems Dick, de Vries Martine
Philosophy Group, Wageningen University.
Medical Ethics, Philosophy and History of Medicine, Erasmus MC.
Public Health Ethics. 2020 Sep 3;13(2):157-165. doi: 10.1093/phe/phaa027. eCollection 2020 Jul.
At the height of the COVID-19 crisis in the Netherlands a shortness of intensive care beds was looming. Dutch professional medical organizations asked a group of ethicists for assistance in drafting guidelines and criteria for selection of patients for intensive care (IC) treatment in case of absolute scarcity, when medical selection criteria would no longer suffice. This article describes the Dutch context, the process of drafting the advice and reflects on the role of ethicists and lessons learned. We argue that timely interaction between clinical and ethical expertise is necessary since the distinction between medical and non-medical considerations is not as clearcut as sometimes assumed. Furthermore, pragmatic considerations related to the specifics of an epidemic are of importance, for example, in relation to prioritizing health care workers. As a consequence, any protocol already present before the pandemic would need alterations to fit the current situation. The 'fair innings' criterion we proposed, rephrased as an argument of intergenerational solidarity, was considered reasonable by professionals as well as patient organizations. While it is desirable to draft ethical guidelines in 'peacetime' as a matter of pandemic preparedness, the pressure of an actual crisis facilitates decision-making, although it will also complicate a more democratic approach.
在荷兰新冠疫情危机最严重的时候，重症监护床位短缺的问题日益凸显。荷兰专业医学组织请求一群伦理学家协助起草在绝对稀缺情况下（即医学选择标准不再适用时）挑选重症监护（IC）治疗患者的指导方针和标准。本文描述了荷兰的背景情况、起草建议的过程，并反思了伦理学家的作用以及汲取的经验教训。我们认为，临床专业知识和伦理专业知识之间的及时互动是必要的，因为医学考量和非医学考量之间的区别并不像有时设想的那么清晰。此外，与疫情具体情况相关的务实考量也很重要，例如在确定医护人员的优先顺序方面。因此，疫情之前已有的任何方案都需要进行调整以适应当前形势。我们提出的“公平寿限”标准，重新表述为代际团结的论点，被专业人士和患者组织认为是合理的。虽然在“和平时期”起草伦理指导方针作为大流行防范措施是可取的，但实际危机带来的压力有助于决策，尽管这也会使更民主的方法变得复杂。
