As the coronavirus disease 2019 (COVID-19) pandemic intensifies, shortages of ventilators have occurred in Italy and are likely imminent in parts of the US. In ordinary clinical circumstances, all patients in need of mechanical ventilation because of potentially-reversible conditions receive it, unless they or their surrogates decline. However, there are mounting concerns in many countries that this will not be possible and that patients who otherwise would likely survive if they received ventilator support will die because no ventilator is available. In this type of public health emergency, the ethical obligation of physicians to prioritize the well-being of individual patients may be overridden by public health policies that prioritize doing the greatest good for the greatest number of patients.1 These circumstances raise a critical question: when demand for ventilators and other intensive treatments far outstrips the supply, what criteria should guide these rationing decisions? Existing recommendations for how to allocate scarce critical care resources during a pandemic or disaster contain ethically problematic provisions, such as categorically excluding large populations of patients from access to scarce intensive care unit (ICU) resources. This

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在 COVID-19 大流行期间配给呼吸机和重症监护病床的框架

随着 2019 年冠状病毒病 (COVID-19) 大流行的加剧，意大利出现了呼吸机短缺的情况，并且在美国部分地区很可能即将出现。在一般临床情况下，所有因潜在可逆条件而需要机械通气的患者都会接受机械通气，除非他们或其替代者下降。然而，在许多国家，人们越来越担心这是不可能的，而且如果他们接受呼吸机支持可能会幸存下来的患者会因为没有呼吸机而死亡。在此类突发公共卫生事件中，医生优先考虑个体患者福祉的道德义务可能会被优先为最多患者带来最大利益的公共卫生政策所取代。 1 这些情况提出了一个关键问题：当呼吸机和其他强化治疗的需求远远超过供应时，应该以什么标准来指导这些配给决定？关于如何在大流行或灾难期间分配稀缺的重症监护资源的现有建议包含道德上有问题的规定，例如明确地将大量患者排除在稀缺的重症监护病房 (ICU) 资源之外。这