Juth Niklas, Hannerz Schmidtke Eva
professor, professor, Centrum för forskningsetik och bioetik, Uppsala universitet.
med dr, specialistläkare, anestesi och intensivvård, bitr överläkare, intensivvårdssektionen, Anopiva, Akademiska sjukhuset, Uppsala.
Lakartidningen. 2024 Sep 18;121:23193.
Priority setting at intensive care units is legally regulated in accordance with the so-called ethical platform, which states that all priorities must be based on three lexically ranked principles: the principle of human dignity (a ban on discrimination, e.g. based on social standing), the principle of needs and solidarity, and the principle of cost-effectiveness. Prioritization for intensive care is particularly difficult as it requires comparisons between widely different patient categories, occurs in acute situations and is fraught with great uncertainty about the prognosis. Sometimes the degree of severity is maximal for several patients: without treatment, they die. Then treatment effect and cost-effectiveness become more decisive for prioritization decisions. Moreover, withholding and withdrawing intensive care are increasingly considered as morally equivalent. Difficult priority decisions risk moral stress among the intensive care staff.
重症监护病房的优先级设定在法律上是根据所谓的伦理平台进行规范的,该平台规定所有优先级必须基于三个按词汇顺序排列的原则:人的尊严原则(禁止基于社会地位等的歧视)、需求与团结原则以及成本效益原则。重症监护的优先级确定尤其困难,因为它需要在差异很大的患者类别之间进行比较,发生在急性情况下,并且预后充满极大的不确定性。有时,几名患者的严重程度达到最大值:不进行治疗,他们就会死亡。那么治疗效果和成本效益就会在优先级决策中变得更加具有决定性。此外,停止和撤销重症监护越来越被视为在道德上是等效的。艰难的优先级决策有可能给重症监护工作人员带来道德压力。