Barilan Yechiel Michael
Special Isolation Emergency and Inpatient Department (COVID-MABAD), Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2021 May;23(5):274-278.
This focus article is a theoretical reflection on the ethics of allocating respirators to patients in circumstances of shortage, especially during the coronavirus disease-2019 (COVID-19) outbreak in Israel. In this article, respirators are placeholders for similar life-saving modalities in short supply, such as extracorporeal membrane oxygenation machines and intensive care unit beds. In the article, I propose a system of triage for circumstances of scarcity of respirators. The system separates the hopeless from the curable, granting every treatable person a real chance of cure. The scarcity situation eliminates excesses of medicine, and then allocates respirators by a single scale, combining an evidence-based scoring system with risk-proportionate lottery. The triage proposed embodies continuity and consistency with the healthcare practices in ordinary times. Yet, I suggest two regulatory modifications: one in relation to expediting review of novel and makeshift solutions and the second in relation to mandatory retrospective research on all relevant medical data and standard (as opposed to experimental) interventions that are influenced by the triage.
这篇焦点文章是对在短缺情况下，特别是在以色列2019年冠状病毒病（COVID-19）疫情期间，为患者分配呼吸器的伦理问题的理论思考。在本文中，呼吸器是体外膜肺氧合机和重症监护病房床位等类似短缺的救生设备的代名词。在本文中，我提出了一种在呼吸器短缺情况下的分诊系统。该系统将无望治愈者与可治愈者区分开来，给予每个可治疗的人真正的治愈机会。短缺情况消除了医疗资源的过度使用，然后通过单一标准分配呼吸器，将基于证据的评分系统与风险比例抽奖相结合。所提出的分诊体现了与平时医疗实践的连续性和一致性。然而，我建议进行两项监管修改：一项是加快对新颖和临时解决方案的审查，另一项是对受分诊影响的所有相关医疗数据和标准（而非实验性）干预措施进行强制性回顾性研究。
