Abstract

During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift—to some degree—from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by “crisis standards of care,” but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities.

 抽象的

在包括 COVID-19 大流行在内的公共卫生危机期间，资源稀缺和传染风险可能需要卫生系统在某种程度上从关注个体患者福祉的通常临床伦理转变为关注个体患者福祉的公共卫生伦理。关于人口健康。许多分诊政策都受到“危机护理标准”提供的法律保护，但它们有关键的区别。我们批判性地评估政策之间最根本的差异之一，即使用标准将某些患者明确排除在其他标准医疗服务的资格之外。我们从道德、法律、残疾和实施的角度审查这些绝对排除标准。将我们的分析重点放在最常见的排除标准类型（特定于疾病）上，我们得出的结论是，重症监护资源分配和心肺复苏（CPR）使用的最佳政策不应使用绝对排除。我们认为，避免绝对排除通常实际上是可行的，符合公共卫生规范，并减少对残疾人的歧视。