Awad Edmond, Bago Bence, Bonnefon Jean-François, Christakis Nicholas A, Rahwan Iyad, Shariff Azim
Department of Economics and Institute for Data Science and Artificial Intelligence, University of Exeter, UK.
Artificial and Natural Intelligence Toulouse Institute and Institute for Advanced Study in Toulouse, Toulouse, France.
MDM Policy Pract. 2022 Jul 25;7(2):23814683221113573. doi: 10.1177/23814683221113573. eCollection 2022 Jul-Dec.
When medical resources are scarce, clinicians must make difficult triage decisions. When these decisions affect public trust and morale, as was the case during the COVID-19 pandemic, experts will benefit from knowing which triage metrics have citizen support. We conducted an online survey in 20 countries, comparing support for 5 common metrics (prognosis, age, quality of life, past and future contribution as a health care worker) to a benchmark consisting of support for 2 no-triage mechanisms (first-come-first-served and random allocation). We surveyed nationally representative samples of 1000 citizens in each of Brazil, France, Japan, and the United States and also self-selected samples from 20 countries (total = 7599) obtained through a citizen science website (the Moral Machine). We computed the support for each metric by comparing its usability to the usability of the 2 no-triage mechanisms. We further analyzed the polarizing nature of each metric by considering its usability among participants who had a preference for no triage. In all countries, preferences were polarized, with the 2 largest groups preferring either no triage or extensive triage using all metrics. Prognosis was the least controversial metric. There was little support for giving priority to healthcare workers. It will be difficult to define triage guidelines that elicit public trust and approval. Given the importance of prognosis in triage protocols, it is reassuring that it is the least controversial metric. Experts will need to prepare strong arguments for other metrics if they wish to preserve public trust and morale during health crises.
We collected citizen preferences regarding triage decisions about scarce medical resources from 20 countries.We find that citizen preferences are universally polarized.Citizens either prefer no triage (random allocation or first-come-first served) or extensive triage using all common triage metrics, with "prognosis" being the least controversial.Experts will need to prepare strong arguments to preserve or elicit public trust in triage decisions.
当医疗资源稀缺时，临床医生必须做出艰难的分诊决策。当这些决策影响公众信任和士气时，就像在新冠疫情期间那样，了解哪些分诊指标得到民众支持将对专家有所帮助。我们在20个国家开展了一项在线调查，将对5种常见指标（预后、年龄、生活质量、过去和未来作为医护人员的贡献）的支持度与由对两种非分诊机制（先到先得和随机分配）的支持度组成的基准进行比较。我们对巴西、法国、日本和美国每个国家具有全国代表性的1000名公民样本进行了调查，还对通过公民科学网站（道德机器）从20个国家获取的自我选择样本（共7599个）进行了调查。我们通过将每个指标的可用性与两种非分诊机制的可用性进行比较来计算对每个指标的支持度。我们还通过考虑每个指标在偏好非分诊的参与者中的可用性，进一步分析了每个指标的两极分化性质。在所有国家，偏好都呈两极分化，最大的两个群体要么倾向于非分诊，要么倾向于使用所有指标进行广泛分诊。预后是争议最小的指标。几乎没有人支持优先考虑医护人员。要制定能赢得公众信任和认可的分诊指南将很困难。鉴于预后在分诊方案中的重要性，令人欣慰的是它是争议最小的指标。如果专家们希望在健康危机期间维护公众信任和士气，就需要为其他指标准备有力论据。
我们收集了来自20个国家的公民对稀缺医疗资源分诊决策的偏好。我们发现公民偏好普遍呈两极分化。公民要么倾向于非分诊（随机分配或先到先得），要么倾向于使用所有常见分诊指标进行广泛分诊，其中“预后”是争议最小的。专家们需要准备有力论据，以维护或赢得公众对分诊决策的信任。
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