Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Erasmus Centre for Health Economics Rotterdam (EsCHER), Rotterdam, The Netherlands.
PLoS One. 2022 Aug 10;17(8):e0270996. doi: 10.1371/journal.pone.0270996. eCollection 2022.
The first wave of the COVID-19 pandemic overwhelmed healthcare systems in many countries, and the rapid spread of the virus and the acute course of the disease resulted in a shortage of intensive care unit (ICU) beds. We studied preferences of the public in the Netherlands regarding the allocation of ICU beds during a health crisis.
We distributed a cross-sectional online survey at the end of March 2020 to a representative sample of the adult population in the Netherlands. We collected preferences regarding the allocation of ICU beds, both in terms of who should be involved in the decision-making and which rationing criteria should be considered. We conducted Probit regression analyses to investigate associations between these preferences and several characteristics and opinions of the respondents.
A total of 1,019 respondents returned a completed survey. The majority favored having physicians (55%) and/or expert committees (51%) play a role in the allocation of ICU beds and approximately one-fifth did not favor any of the proposed decision-makers. Respondents preferred to assign higher priority to vulnerable patients and patients who have the best prospect of full recovery. They also preferred that personal characteristics, including age, play no role.
"Our findings show that current guidelines for allocating ICU beds that include age as an independent criterion may not be consistent with societal preferences. Age may only play a role indirectly, in relation to the vulnerability of patients and their prospect of full recovery. Allocation of ICU beds during a health crisis requires a multivalue ethical framework."
COVID-19 大流行的第一波疫情使许多国家的医疗体系不堪重负，病毒的迅速传播和疾病的急性病程导致重症监护病房（ICU）床位短缺。我们研究了荷兰公众在卫生危机期间对 ICU 床位分配的偏好。
我们在 2020 年 3 月底向荷兰成年人口的代表性样本分发了一份横断面在线调查。我们收集了关于 ICU 床位分配的偏好，包括谁应该参与决策以及应该考虑哪些配给标准。我们进行了 Probit 回归分析，以调查这些偏好与受访者的几个特征和意见之间的关联。
共有 1019 名受访者返回了完整的调查。大多数人赞成让医生（55%）和/或专家委员会（51%）在 ICU 床位分配中发挥作用，约五分之一的人不赞成任何提议的决策者。受访者更倾向于优先考虑弱势患者和最有可能完全康复的患者。他们还希望个人特征，包括年龄，不发挥作用。
“我们的研究结果表明，目前将年龄作为独立标准纳入 ICU 床位分配的指南可能不符合社会偏好。年龄可能仅间接与患者的脆弱性及其完全康复的前景有关。在卫生危机期间分配 ICU 床位需要一个多值伦理框架。”
