Subject(s)
Continuous Positive Airway Pressure/instrumentation , Noninvasive Ventilation/instrumentation , Safety-Based Medical Device Withdrawals/standards , Ventilators, Mechanical/standards , Continuous Positive Airway Pressure/adverse effects , Continuous Positive Airway Pressure/ethics , Continuous Positive Airway Pressure/standards , Humans , Informed Consent/ethics , Informed Consent/standards , Noninvasive Ventilation/adverse effects , Noninvasive Ventilation/ethics , Noninvasive Ventilation/standards , Patient Participation/methods , Patient-Centered Care/ethics , Patient-Centered Care/methods , Patient-Centered Care/standards , Practice Guidelines as Topic , Practice Patterns, Physicians'/ethics , Practice Patterns, Physicians'/standards , Safety-Based Medical Device Withdrawals/ethics , Societies, Medical/ethics , Societies, Medical/standards , United States , Ventilators, Mechanical/adverse effects , Ventilators, Mechanical/ethicsABSTRACT
BACKGROUND: This focus article is a theoretical reflection on the ethics of allocating respirators to patients in circumstances of shortage, especially during the coronavirus disease-2019 (COVID-19) outbreak in Israel. In this article, respirators are placeholders for similar life-saving modalities in short supply, such as extracorporeal membrane oxygenation machines and intensive care unit beds. In the article, I propose a system of triage for circumstances of scarcity of respirators. The system separates the hopeless from the curable, granting every treatable person a real chance of cure. The scarcity situation eliminates excesses of medicine, and then allocates respirators by a single scale, combining an evidence-based scoring system with risk-proportionate lottery. The triage proposed embodies continuity and consistency with the healthcare practices in ordinary times. Yet, I suggest two regulatory modifications: one in relation to expediting review of novel and makeshift solutions and the second in relation to mandatory retrospective research on all relevant medical data and standard (as opposed to experimental) interventions that are influenced by the triage.
Subject(s)
COVID-19/therapy , Resource Allocation/ethics , Triage/methods , Ventilators, Mechanical/supply & distribution , COVID-19/epidemiology , Disease Outbreaks , Ethical Analysis , Extracorporeal Membrane Oxygenation/instrumentation , Humans , Intensive Care Units/ethics , Intensive Care Units/supply & distribution , Israel , Triage/ethics , Ventilators, Mechanical/ethicsSubject(s)
Clinical Decision-Making , Coronavirus Infections/therapy , Critical Care/ethics , Pandemics/ethics , Pneumonia, Viral/therapy , Surge Capacity/ethics , Ventilators, Mechanical/ethics , Attitude of Health Personnel , Betacoronavirus , COVID-19 , Ethics, Medical , Humans , Intensive Care Units/ethics , SARS-CoV-2ABSTRACT
El 5 de agosto de 2020, tuvo lugar la 30ma edición del programa de Webinars de RedETSA. La Dra. Carla Sáenz, Asesora Regional en Bioética de la OPS dio una presentación sobre Uso de emergencia de intervenciones no probadas y fuera del ámbito de la investigación: Orientación ética para la pandemia de COVID-19.
Subject(s)
Treatment Outcome , Bioethical Issues , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Pandemics/ethics , Ethics, Clinical , Patient Safety , Off-Label Use/ethics , Anti-Bacterial Agents/therapeutic use , Betacoronavirus/drug effects , Clinical Trial Protocol , PAHO Ethics Review Committee , Proof of Concept Study , Case Management/ethics , Ventilators, Mechanical/ethics , Plasma/immunology ,Subject(s)
Clinical Competence , Health Care Rationing/ethics , Health Services Needs and Demand/ethics , Pandemics , Surgeons/ethics , Thoracic Surgical Procedures/ethics , Extracorporeal Membrane Oxygenation/ethics , Extracorporeal Membrane Oxygenation/instrumentation , Heart-Assist Devices/ethics , Heart-Assist Devices/supply & distribution , Humans , Respiration, Artificial/ethics , Respiration, Artificial/instrumentation , Surge Capacity/ethics , Ventilators, Mechanical/ethics , Ventilators, Mechanical/supply & distributionABSTRACT
EDs fulfil a frontline function during public health emergencies (PHEs) and will play a pivotal role during the COVID-19 pandemic. This perspective article draws on qualitative data from a longitudinal, ethnographic study of an Australian tertiary ED to illustrate the clinical and ethical challenges faced by EDs during PHEs. Interview data collected during the 2014 Ebola Virus Disease PHE of International Concern suggest that ED clinicians have a strong sense of professional responsibility, but this can be compromised by increased visibility of risk and sub-optimal engagement from hospital managers and public health authorities. The study exposes the tension between a healthcare worker's right to protection and a duty to provide treatment. Given the narrow window of opportunity to prepare for a surge of COVID-19 presentations, there is an immediate need to reflect and learn from previous experiences. To maintain the confidence of ED clinicians, and minimise the risk of moral injury, hospital and public health authorities must urgently develop processes to support ethical healthcare delivery and ensure adequate resourcing of EDs.
Subject(s)
Coronavirus Infections/diagnosis , Coronavirus , Disease Outbreaks/ethics , Emergency Medicine/ethics , Emergency Service, Hospital/ethics , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Ventilators, Mechanical/ethics , Betacoronavirus , COVID-19 , Coronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Decision Making , Disease Outbreaks/prevention & control , Emergency Medical Services , Hemorrhagic Fever, Ebola/epidemiology , Humans , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Public Health , SARS-CoV-2 , Ventilators, Mechanical/statistics & numerical dataSubject(s)
Beds/supply & distribution , Betacoronavirus , Coronavirus Infections/epidemiology , Health Care Rationing/ethics , Pneumonia, Viral/epidemiology , Ventilators, Mechanical/supply & distribution , Age Factors , Beds/ethics , COVID-19 , Critical Care/ethics , Ethics, Clinical , Health Personnel , Humans , Life Cycle Stages , Pandemics , Patient Selection/ethics , Public Health/ethics , Quality-Adjusted Life Years , SARS-CoV-2 , Triage/ethics , Triage/methods , Ventilators, Mechanical/ethics , Withholding Treatment/ethicsABSTRACT
In Japanese context, there has been a controversy concerning the withdrawal of life-support, i.e. respiratory system, from ALS patients when, along of the progress of the disease, they have become not able to express themselves at all to people around them, i.e. when they are in so called 'totally locked in state (TLS)'. Basing himself on the system of clinical ethics he has been developing in accord with Japanese culture, the author (1) reconstitutes the logic of justifying the withdrawal in dispute, (2) examines objections against officially recognizing such withdrawal, and (3) proposes an appropriate process of decision making which he hopes to be acceptable to both sides in the controversy.
Subject(s)
Amyotrophic Lateral Sclerosis/therapy , Ethics, Clinical , Life Support Systems/ethics , Ventilators, Mechanical/ethics , Withholding Treatment/ethics , Amyotrophic Lateral Sclerosis/physiopathology , Culture , Decision Making/ethics , Humans , JapanABSTRACT
This essay examines the management of ventilatory failure in disaster settings where clinical needs overwhelm available resources. An ethically defensible approach in such settings will adopt a "sufficiency of care" perspective that is: (1) adaptive, (2) resource-driven, and (3) responsive to the values of populations being served. Detailed, generic, antecedently written guidelines for "ventilator triage" or other management issues typically are of limited value, and may even impede ethical disaster response if they result in rescuers' clumsily interpreting events through the lens of the guideline, rather than customizing tactics to the actual context. Especially concerning is the tendency of some expert planners to mistakenly assume that medical treatment of respiratory failure: (1) always requires full-feature mechanical ventilators, (2) will always occur in hospitals, and (3) can be planned in advance without sophisticated public consultation about likely ethical dilemmas.
