Graduate Program in Philosophy, National Council for Scientific and Technological Development (CNPq), Federal University of Rio de Janeiro, Law School, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
Graduate Program in Philosophy, National Council for Scientific and Technological Development (CNPq), School of Humanities, University of Vale dos Sinos, São Leopoldo, Brazil.
J Eval Clin Pract. 2024 Aug;30(5):756-765. doi: 10.1111/jep.13924. Epub 2023 Oct 15.
In the context of a major health crisis, health professionals must first compare patients' recovery prospects, thus giving priority to the goal of saving the greatest number of lives.
Critically evaluate a protocol for allocation of scarce intensive care units (ICU), which the authors proposed at the onset of the COVID-19 pandemic and originally published in two Brazilian newspapers; and compare that protocol with similar proposals, particularly with 2 successive protocols issued by the Brazilian Critical Care Association. The main objective is to highlight the advantages of the authors' approach and discuss some criticisms that has been levelled against the proposed protocol after its original publication in 2020.
Comparative analysis of 3 different protocols (the authors' proposed protocol and 2 successive protocols issued by the Brazilian Critical Care Association) with regard to ethical principles.
The main objective of a healthcare system is to ensure a fair patient triage process when it is impossible to grant admission to all patients in need of treatment. Decision-making regarding the impartial prioritization of ICU admissions must be based primarily on clinical criteria. The Sequential Organ Failure Assessment (SOFA) is, for ethical and technical reasons, a useful tool for clinical assessments of patients. Based on three ranges of SOFA scores, patients can be classified into a "high", a "medium", and a "low" priority group. In the case of ties, the life cycle principle must be the tiebreaker. If the tie persists, a draw must be used.
The authors' proposed protocol has advantages over the other two protocols due to its greater practicality and capacity to account for egalitarian and consequentialist principles simultaneously. It aims at saving as many lives as possible within the constraints of fairness. Furthermore, the proposed protocol avoids discrimination against people with disabilities without, at the same time, promoting discrimination against the elderly.
在重大健康危机的背景下，医疗专业人员必须首先比较患者的康复前景，从而优先考虑拯救最多生命的目标。
批判性地评估一项在 COVID-19 大流行开始时作者提出并最初发表在两份巴西报纸上的稀缺重症监护病房（ICU）分配方案；并将该方案与类似的建议进行比较，特别是与巴西危重病协会发布的两个连续方案进行比较。主要目的是强调作者方法的优势，并讨论在 2020 年该方案最初发表后对该方案提出的一些批评。
从伦理原则的角度对 3 种不同的方案（作者提出的方案和巴西危重病协会发布的 2 个连续方案）进行比较分析。
医疗保健系统的主要目标是在不可能为所有需要治疗的患者提供治疗的情况下，确保公平的患者分诊过程。关于 ICU 入院的公平优先排序的决策必须主要基于临床标准。序贯器官衰竭评估（SOFA）出于伦理和技术原因，是对患者进行临床评估的有用工具。根据 SOFA 评分的三个范围，患者可以分为“高”、“中”和“低”优先级组。在平局的情况下，生命周期原则必须是打破平局的因素。如果平局仍然存在，则必须使用平局。
由于其更大的实用性和同时考虑平等主义和后果主义原则的能力，作者提出的方案优于其他两个方案。它旨在在公平的限制内拯救尽可能多的生命。此外，该方案避免了对残疾人士的歧视，同时也没有对老年人进行歧视。
