National Centre for Clinical Excellence Healthcare Quality and Safety, Istituto Superiore di Sanità, Rome, Italy.
Department of Health Promotion Science, Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy.
Clin Ter. 2022 Jul-Aug;173(4):384-395. doi: 10.7417/CT.2022.2450.
To investigate whether and how ten ethical principles are mentioned within documents on critical care resources allocation during public health emergencies.
We conducted a search of documents con-cerning critical resources allocation during public emergencies publicly available from Google and two specific international websites, up to November 2020. Each document was analyzed by two independent reviewers to assess whether a reference to any of the 10 key ethical principles indicated by the Northern Italy Ethical Committee could be found in the documents. Cohen's K statistic was used.
We obtained 34 documents, of which 19 were allocation frameworks, 15 crisis standards of care, 4 clinical triage protocol, 3 clinical guidelines and 2 public health emergency response plans. The principles most frequently mentioned as important for decision-making was "number of lives saved", followed by "transparency", "equity", "respect of person and their autonomy". The most cited tiebreakers were "younger first/life cycle" and "lottery".
All documents aim to protect the life and health of the largest number of people and should be objective, ethical, transparent, applied equitably, and be publicly disclosed. It is plausible that short- and long-term prognostic tools can help allocate critical resources, but it remains strong that the decision-making process must be guided by a multi-principle ethical model that is not always easy to apply.
调查在公共卫生紧急情况下的重症监护资源分配文件中是否以及如何提到了十大伦理原则。
我们对截至 2020 年 11 月在 Google 和两个特定的国际网站上公开的有关公共卫生紧急情况下关键资源分配的文件进行了搜索。由两名独立的评审员对每份文件进行分析，以评估文件中是否提到了意大利北部伦理委员会所指出的 10 项关键伦理原则之一。采用 Cohen 的 K 统计量。
我们获得了 34 份文件，其中 19 份是分配框架，15 份是危机护理标准，4 份是临床分诊协议，3 份是临床指南，2 份是公共卫生应急计划。在决策中被认为最重要的原则是“拯救的生命数量”，其次是“透明度”、“公平”、“尊重个人及其自主权”。最常被引用的决断标准是“先救年轻的/生命周期”和“抽签”。
所有文件都旨在保护大多数人的生命和健康，应该是客观的、合乎伦理的、透明的、公平适用的，并应公开披露。短期和长期预后工具可能有助于分配关键资源，但决策过程必须遵循多原则的伦理模型，这并不总是容易应用的。
