Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, OX1 1PT, Oxford, UK.
John Radcliffe Hospital, Oxford, UK.
Health Care Anal. 2021 Dec;29(4):263-282. doi: 10.1007/s10728-020-00427-5. Epub 2021 Feb 6.
In the first wave of the COVID-19 pandemic, healthcare workers in some countries were forced to make distressing triaging decisions about which individual patients should receive potentially life-saving treatment. Much of the ethical discussion prompted by the pandemic has concerned which moral principles should ground our response to these individual triage questions. In this paper we aim to broaden the scope of this discussion by considering the ethics of broader structural allocation decisions raised by the COVID-19 pandemic. More specifically, we consider how nations ought to distribute a scarce life-saving resource across healthcare regions in a public health emergency, particularly in view of regional differences in projected need and existing capacity. We call this the regional triage question. Using the case study of ventilators in the COVID-19 pandemic, we show how the moral frameworks that we might adopt in response to individual triage decisions do not translate straightforwardly to this regional-level triage question. Having outlined what we take to be a plausible egalitarian approach to the regional triage question, we go on to propose a novel way of operationalising the 'save the most lives' principle in this context. We claim that the latter principle ought to take some precedence in the regional triage question, but also note important limitations to the extent of the influence that it should have in regional allocation decisions.
在 COVID-19 大流行的第一波中，一些国家的医护人员被迫就哪些个体患者应接受潜在救生治疗做出痛苦的分类决策。大流行引发的大部分伦理讨论都涉及哪些道德原则应该成为我们对这些个体分类问题的回应的基础。在本文中，我们旨在通过考虑 COVID-19 大流行引发的更广泛的结构性分配决策的伦理问题来扩大讨论范围。更具体地说，我们考虑在公共卫生紧急情况下，国家应该如何在医疗保健区域之间分配稀缺的救生资源，特别是考虑到预期需求和现有能力的区域差异。我们将这个问题称为区域分类问题。我们使用 COVID-19 大流行期间呼吸机的案例研究，展示了我们可能在应对个体分类决策时采用的道德框架如何不能直接转化为这个区域层面的分类问题。在概述了我们对区域分类问题的一种合理的平等主义方法之后，我们接着提出了在这种情况下实施“拯救最多生命”原则的一种新方法。我们声称，后者原则在区域分类问题中应该优先考虑，但也注意到它在区域分配决策中应该具有的影响程度存在重要限制。
