Director of the Ethics Center at Cincinnati Children's Hospital Medical Center and Professor of Pediatrics at the University of Cincinnati College of Medicine in Cincinnati, OH USA.
Director of the Division of Social Services at Cincinnati Children's Hospital Medical Center in Cincinnati, OH USA.
J Clin Ethics. 2021 Spring;32(1):38-47.
Nonpharmaceutical interventions to minimize the transmission of the severe acute respiratory syndrome coronavirus 2 are necessary because we currently lack a vaccine or specific treatments. Healthcare facilities have adopted visitor restrictions and masking requirements. These interventions should be evaluated as public health measures, focusing on their efficacy, the availability of less-restrictive alternatives, and the minimization of the burdens and their balance with the benefits. These interventions, as well as exceptions, can be justified by the same analysis. For example, visitor restrictions are sound, as are exceptions for women in labor, adults with disabilities, minor children, and individuals who are dying. In implementing these policies, specific rules are preferable to general principles because they are more efficient and reduce possible bias. There should, however, be appeal mechanisms and retrospective review processes. Evaluating requests for medical exemptions to masking requirements is particularly difficult, given the prevalence of nonmedical objections, false claims of medical exemptions, and a lack of objective medical criteria. Requiring written statements by licensed healthcare providers that undergo subsequent substantive review may therefore be justified.
由于我们目前缺乏疫苗或特定的治疗方法，因此必须采取非药物干预措施，将严重急性呼吸综合征冠状病毒 2 的传播降到最低。医疗机构已经采取了访客限制和口罩佩戴要求。这些干预措施应作为公共卫生措施进行评估，重点关注其效果、有无限制较少的替代措施，以及最小化负担及其与效益的平衡。这些干预措施以及例外情况都可以通过相同的分析来证明其合理性。例如，访客限制是合理的，分娩妇女、残疾成年人、未成年儿童和临终患者的例外情况也是合理的。在实施这些政策时，具体规则比一般原则更有效，因为它们更高效，并且可以减少可能存在的偏见。但是，应该有上诉机制和回顾性审查流程。由于存在非医疗反对意见、虚假的医疗豁免声称以及缺乏客观的医学标准，因此评估对口罩佩戴要求的医疗豁免请求特别困难。因此，可能有理由要求由持照医疗保健提供者出具书面声明，并进行后续实质性审查。
