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Age Alone is not Adequate to Determine Health-care Resource Allocation During the COVID-19 Pandemic.仅年龄不足以决定新冠疫情期间的医疗资源分配。
Can Geriatr J. 2020 Mar 1;23(1):152-154. doi: 10.5770/cgj.23.452. eCollection 2020 Mar.
2
Utilitarianism and the pandemic.功利主义与大流行病
Bioethics. 2020 Jul;34(6):620-632. doi: 10.1111/bioe.12771.
3
AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond.AGS 立场声明:COVID-19 时代及以后的资源分配策略和与年龄相关的考虑因素。
J Am Geriatr Soc. 2020 Jun;68(6):1136-1142. doi: 10.1111/jgs.16537.
4
COVID-19 in Italy: Ageism and Decision Making in a Pandemic.意大利的新冠疫情:大流行中的年龄歧视与决策制定
J Am Med Dir Assoc. 2020 May;21(5):576-577. doi: 10.1016/j.jamda.2020.03.025. Epub 2020 Apr 1.
5
[Clinical ethics recommendations for the allocation of intensive care treatments, in exceptional, resource-limited circumstances.].[在特殊的、资源有限的情况下,关于重症监护治疗分配的临床伦理建议。]
Recenti Prog Med. 2020 Apr;111(4):207-211. doi: 10.1701/3347.33183.
6
Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy.意大利新冠肺炎死亡患者的病死率及特征
JAMA. 2020 May 12;323(18):1775-1776. doi: 10.1001/jama.2020.4683.
7
Fair Allocation of Scarce Medical Resources in the Time of Covid-19.新冠疫情期间稀缺医疗资源的公平分配
N Engl J Med. 2020 May 21;382(21):2049-2055. doi: 10.1056/NEJMsb2005114. Epub 2020 Mar 23.
8
Facing Covid-19 in Italy - Ethics, Logistics, and Therapeutics on the Epidemic's Front Line.意大利应对新冠疫情——疫情前线的伦理、后勤与治疗
N Engl J Med. 2020 May 14;382(20):1873-1875. doi: 10.1056/NEJMp2005492. Epub 2020 Mar 18.
9
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.中国武汉成人 COVID-19 住院患者的临床病程和死亡危险因素:一项回顾性队列研究。
Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3. Epub 2020 Mar 11.
10
Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures.新型冠状病毒肺炎(COVID-19)具有独特的流行病学和临床特征,提示应采取特殊的控制措施。
J Med Virol. 2020 Jun;92(6):568-576. doi: 10.1002/jmv.25748. Epub 2020 Mar 29.

新冠疫情时代的年龄:伦理分析

Age in the Time of COVID-19: An Ethical Analysis.

作者信息

Hostiuc Sorin, Negoi Ionut, Maria-Isailă Oana, Diaconescu Ioana, Hostiuc Mihaela, Drima Eduard

机构信息

1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

2National Institute of Legal Medicine, Bucharest, Romania.

出版信息

Aging Dis. 2021 Feb 1;12(1):7-13. doi: 10.14336/AD.2020.0929. eCollection 2021 Feb.

DOI:10.14336/AD.2020.0929
PMID:33532122
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7801273/
Abstract

Despite using a myriad of methods to combat the spread of COVID-19, the healthcare systems (especially the intensive care units) have been overwhelmed, showing an outpaced capacity of available beds and ventilators. Choosing the right criteria to allocate the scarce ICU seems very challenging, being necessary a rapid, uncomplicated and universally accepted tool for patients' triage regarding access to lifesaving resources; one such criterion, which generates intense debates, is age. Under certain circumstances, it might seem appropriate to choose to treat a young over an old patient. The main advantage of this approach is the potential for long-term survival, implying an equal right to reach an advanced age. Many authors have given moral reasons to support it, mainly based on utilitarian ethics or on distributive justice. However, there are numerous counterarguments to this approach, which we will summarize in this article. We will show that age should never be used as a unique criterion for withholding/not initiating life-saving procedures, even in pandemics or cases in which healthcare resources are extremely scarce. This approach is based on fundamental Codes of Ethics, such as the WMA Code of Ethics or the Oath of Hippocrates and all physicians treating patients should obey them.

摘要

尽管采用了无数方法来抗击新冠病毒的传播,但医疗系统(尤其是重症监护病房)仍不堪重负,可用病床和呼吸机的容量已告不足。选择正确的标准来分配稀缺的重症监护资源似乎极具挑战性,因此需要一种快速、简便且被普遍接受的工具,用于对患者进行分诊以获取救生资源;其中一个引发激烈辩论的标准就是年龄。在某些情况下,选择治疗年轻患者而非老年患者似乎是合适的。这种方法的主要优势在于患者有长期存活的可能性,这意味着拥有活到高龄的平等权利。许多作者给出了道德理由来支持这一观点,主要基于功利主义伦理或分配正义。然而,这种方法存在诸多反对意见,我们将在本文中进行总结。我们将表明,年龄绝不应被用作拒绝/不启动救生程序的唯一标准,即使在大流行或医疗资源极其稀缺的情况下也是如此。这种方法基于基本的道德准则,如世界医学协会道德准则或希波克拉底誓言,所有治疗患者的医生都应遵守这些准则。