Eliminating Categorical Exclusion Criteria in Crisis Standards of Care Frameworks
Eliminating Categorical Exclusion Criteria in Crisis Standards of Care Frameworks
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DOI：
10.1080/15265161.2020.1764141
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发表时间：
2020-05-15
影响因子：
13.4
通讯作者：
Halpern, Scott D.
中科院分区：
文献类型：
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作者：
Auriemma, Catherine L.;Molinero, Ashli M.;Halpern, Scott D.
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要求卫生系统在某种程度上从关注个体患者福祉的常规临床伦理转变为关注人口健康的公共卫生伦理。许多分流政策都属于“危机护理标准”提供的法律的保护范围，但它们有关键的区别。我们批判性地评价了政策之间最根本的区别之一，即使用标准来明确排除某些患者获得其他标准医疗服务的资格。我们从伦理、法律的、残疾和实施的角度来研究这些明确的排除标准。我们的分析集中在最常见类型的排除标准，这是疾病特异性，我们的结论是，重症监护资源分配和心肺复苏术（CPR）的使用的最佳政策不应该使用分类排除。我们认为，避免绝对排除往往是实际可行的，符合公共卫生规范，并减少对残疾人的歧视。
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.