University of Oxford.
John Radcliffe Hospital.
Am J Bioeth. 2021 Nov;21(11):48-63. doi: 10.1080/15265161.2020.1851809. Epub 2020 Dec 8.
In early 2020, a number of countries developed and published intensive care triage guidelines for the pandemic. Several of those guidelines, especially in the UK, encouraged the explicit assessment of clinical frailty as part of triage. Frailty is relevant to resource allocation in at least three separate ways, through its impact on probability of survival, longevity and quality of life (though not a fourth-length of intensive care stay). I review and reject claims that frailty-based triage would represent unjust discrimination on the grounds of age or disability. I outline three important steps to improve the ethical incorporation of frailty into triage. Triage criteria (ie frailty) should be assessed consistently in all patients referred to the intensive care unit. Guidelines must make explicit the ethical basis for the triage decision. This can then be applied, using the concept of triage equivalence, to other (non-frail) patients referred to intensive care.
2020 年初，许多国家制定并发布了大流行期间的重症监护分诊指南。其中一些指南，特别是在英国，鼓励明确评估临床脆弱性作为分诊的一部分。脆弱性至少通过以下三种方式与资源分配有关，通过对生存概率、寿命和生活质量的影响（尽管不是第四种——重症监护停留时间）。我审查并驳斥了脆弱性分诊将基于年龄或残疾而构成不公正歧视的说法。我概述了将脆弱性纳入分诊的三个重要步骤，以改善其伦理应用。在所有被转往重症监护病房的患者中，都应一致评估分诊标准（即脆弱性）。指南必须明确说明分诊决策的伦理基础。然后，可以使用分诊等效性的概念，将其应用于转往重症监护的其他（非脆弱性）患者。
