Abstract

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing policies for pandemics differ by institution, health system, and applicable law. Most seem to agree that a patient’s ability to benefit from treatment and to survive are first-order considerations. However, there is debate about what clinical measures should be used to make that determination and about other factors that might be ethically appropriate to consider. In this paper, we discuss resource allocation and several related ethical challenges to the healthcare system and society, including how to define benefit, how to handle informed consent, the special needs of pediatric patients, how to engage communities in these difficult decisions, and how to mitigate concerns of discrimination and the effects of structural inequities.

摘要

COVID-19大流行引发了许多道德挑战，但其中最关键的是卫生保健系统可能需要对稀缺的重症监护资源进行定量分配。大流行的配给政策因机构，卫生系统和适用法律而异。大多数人似乎都同意，患者从治疗中受益和生存的能力是首要考虑因素。但是，关于应该使用哪种临床措施进行该决定以及在伦理上可能适当考虑的其他因素，存在争议。在本文中，我们讨论了资源分配以及医疗系统和社会面临的一些相关的道德挑战，包括如何定义利益，如何处理知情同意，儿科患者的特殊需求，如何让社区参与这些困难的决定，