Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.
J Med Ethics. 2022 Aug;48(8):504-509. doi: 10.1136/medethics-2021-107255. Epub 2021 May 21.
The COVID-19 pandemic has strained healthcare resources the world over, requiring healthcare providers to make resource allocation decisions under extraordinary pressures. A year later, our understanding of COVID-19 has advanced, but our process for making ethical decisions surrounding resource allocation has not. During the first wave of the pandemic, our institution uniformly ramped-down clinical activity to accommodate the anticipated demands of COVID-19, resulting in resource waste and inefficiency. In preparation for the second wave, we sought to make such ramp down decisions more prudently and ethically. We report the development of a tool that can be used to make fair and ethical decisions in times of resource scarcity. We formed an interprofessional team to develop and use this tool to ensure that a diverse range of stakeholder perspectives were represented in this development process. This team, called the clinical activity recovery team, established institutional objectives that were combined with well-established procedural values, substantive ethical principles and decision-making criteria by using a variation on the well-known accountability for reasonableness ethical framework. The result of this is a stepwise, semiquantitative, ethical decision tool that can be applied to resource allocation challenges in order to reach fair and ethically defensible decisions. This ethical decision tool can be applied in various contexts and may prove useful at both the institutional and the departmental level; indeed this is how it is applied at our centre. As the second wave of COVID-19 strains healthcare resources, this tool can help clinical leaders to make fair decisions.
新冠疫情使全球各地的医疗资源紧张，迫使医疗服务提供者在巨大压力下做出资源分配决策。一年后，我们对新冠疫情的认识有所提高，但我们制定资源分配伦理决策的过程却没有。在疫情的第一波期间，我们机构统一缩减了临床活动，以适应对新冠疫情的预期需求，导致资源浪费和效率低下。为了应对第二波疫情，我们试图更谨慎、更合乎道德地做出这种缩减决策。我们报告了一种工具的开发，该工具可用于在资源短缺时做出公平和合乎道德的决策。我们组建了一个多专业团队来开发和使用该工具，以确保在这一开发过程中代表不同利益相关者的广泛观点。该团队称为临床活动恢复团队，其结合了既定的程序价值观、实质性伦理原则和决策标准，使用了著名的合理责任伦理框架的变体，确立了机构目标。其结果是一个逐步的、半定量的伦理决策工具，可用于资源分配挑战，以做出公平和具有道德辩护的决策。该伦理决策工具可应用于各种情况，在机构和部门层面都可能证明有用；实际上，这就是我们在中心应用它的方式。随着第二波新冠疫情使医疗资源紧张，该工具可以帮助临床领导者做出公平的决策。
