Center for Health Humanities and Ethics, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
Center for Health Humanities and Ethics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
J Med Ethics. 2021 Sep;47(9):599-602. doi: 10.1136/medethics-2021-107248. Epub 2021 Jun 25.
Policies promoted and adopted for allocating ventilators during the COVID-19 pandemic have often prioritised healthcare workers or other essential workers. While the need for such policies has so far been largely averted, renewed stress on health systems from continuing surges, as well as the experience of allocating another scarce resource-vaccination-counsel revisiting the justifications for such prioritisation. Prioritising healthcare workers may have intuitive appeal, but the ethical justifications for doing so and the potential harms that could follow require careful analysis. Ethical justifications commonly offered for healthcare worker prioritisation for ventilators rest on two social value criteria: (1) instrumental value, also known as the 'multiplier effect', which may preserve the ability of healthcare workers to help others, and (2) reciprocity, which rewards past usefulness or sacrifice. We argue that these justifications are insufficient to over-ride the common moral commitment to value each person's life equally. Institutional policies prioritising healthcare workers over other patients also violate other ethical norms of the healthcare professions, including the commitment to put patients first. Furthermore, policy decisions to prioritise healthcare workers for ventilators could engender or deepen existing distrust of the clinicians, hospitals and health systems where those policies exist, even if they are never invoked.
在 COVID-19 大流行期间，为分配呼吸机而推行和采用的政策通常优先考虑医护人员或其他必要工作人员。虽然到目前为止，这种政策的需求在很大程度上已经避免了，但由于持续的激增，医疗系统再次面临压力，以及分配另一种稀缺资源——疫苗接种的经验，需要重新考虑这种优先排序的理由。优先考虑医护人员可能具有直观的吸引力，但这样做的伦理理由和可能随之而来的潜在危害需要仔细分析。为医护人员优先分配呼吸机提供的常见伦理理由基于两个社会价值标准：（1）工具价值，也称为“乘数效应”，这可能有助于医护人员帮助他人的能力，以及（2）互惠，这是对过去的有用性或牺牲的回报。我们认为，这些理由不足以推翻普遍的道德承诺，即平等重视每个人的生命。将医护人员置于其他患者之上的机构政策也违反了医疗保健行业的其他伦理规范，包括将患者放在首位的承诺。此外，为医护人员优先分配呼吸机的政策决策可能会在这些政策存在的地方产生或加深对临床医生、医院和卫生系统的现有不信任，即使这些政策从未被援引过。
