The Ethics of Creating a Resource Allocation Strategy During the COVID-19 Pandemic
The Ethics of Creating a Resource Allocation Strategy During the COVID-19 Pandemic
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DOI：
10.1542/peds.2020-1243
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发表时间：
2020-07-01
期刊：
影响因子：
8
通讯作者：
Macauley, Robert
中科院分区：
文献类型：
--
作者：
Laventhal, Naomi;Basak, Ratna;Macauley, Robert
2019年冠状病毒病大流行几乎影响了医学的各个方面，给临床医生带来了许多道德困境。这些困境中最重要的是如何描述和实施危机护理标准，特别是如何考虑在短缺时期如何分配卫生保健资源。我们回顾了灾害规划和资源管理的基本原则，以及与本次和未来公共卫生危机的伦理相关性，探讨了疾病严重程度评分系统的作用及其局限性和对健康差距的潜在贡献，并考虑了异常资源密集型干预措施的作用。我们还回顾了危机护理标准的哲学和实践基础，并描述了稀缺资源分配的历史方法，为儿科临床医生提供分析和指导。特别注意到这一努力对儿童的影响。虽然很少有儿童因有症状感染而需要住院治疗，但儿童仍有可能受到大流行对卫生保健系统造成的压力的深刻影响，应在资源分配框架中予以前瞻性考虑。
The coronavirus disease 2019 pandemic has affected nearly every aspect of medicine and raises numerous moral dilemmas for clinicians. Foremost of these quandaries is how to delineate and implement crisis standards of care and, specifically, how to consider how health care resources should be distributed in times of shortage. We review basic principles of disaster planning and resource stewardship with ethical relevance for this and future public health crises, explore the role of illness severity scoring systems and their limitations and potential contribution to health disparities, and consider the role for exceptionally resource-intensive interventions. We also review the philosophical and practical underpinnings of crisis standards of care and describe historical approaches to scarce resource allocation to offer analysis and guidance for pediatric clinicians. Particular attention is given to the impact on children of this endeavor. Although few children have required hospitalization for symptomatic infection, children nonetheless have the potential to be profoundly affected by the strain on the health care system imposed by the pandemic and should be considered prospectively in resource allocation frameworks.