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2.
Neurol Sci ; 42(2): 437-444, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33389228

RESUMO

Coronavirus disease 2019 (COVID-19) pandemic has struck many countries and caused a great number of infected cases and death. Healthcare system across all countries is dealing with the increasing medical, social, and legal issues caused by the COVID-19 pandemic, and the standards of care are being altered. Admittedly, neurology units have been influenced greatly since the first days, as aggressive policies adopted by many hospitals caused eventual shut down of numerous neurologic wards. Considering these drastic alterations, traditional ethical principles have to be integrated with state-of-the-art ethical considerations. This review will consider different ethical aspects of care in neurologic patients during COVID-19 and how this challenging situation has affected standards of care in these patients.


Assuntos
Procedimentos Endovasculares/ética , Doenças do Sistema Nervoso/terapia , Neurologia/ética , Cuidados Paliativos/ética , Sistemas de Apoio Psicossocial , Respiração Artificial/ética , Triagem/ética , Humanos
3.
J Med Ethics ; 47(2): 108-112, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33335068

RESUMO

One prominent view in recent literature on resource allocation is Persad, Emanuel and Wertheimer's complete lives framework for the rationing of lifesaving healthcare interventions (CLF). CLF states that we should prioritise the needs of individuals who have had less opportunity to experience the events that characterise a complete life. Persad et al argue that their system is the product of a successful process of reflective equilibrium-a philosophical methodology whereby theories, principles and considered judgements are balanced with each other and revised until we achieve an acceptable coherence between our various beliefs. Yet I argue that many of the principles and intuitions underpinning CLF conflict with each other, and that Persad et al have failed to achieve an acceptable coherence between them. I focus on three tensions in particular: the conflict between the youngest first principle and Persad et al's investment refinement; the conflict between current medical need and a concern for lifetime equality; and the tension between adopting an objective measure of complete lives and accommodating for differences in life narratives.


Assuntos
Tomada de Decisões/ética , Ética Clínica , Alocação de Recursos para a Atenção à Saúde/ética , Equidade em Saúde/ética , Justiça Social , Triagem/ética , Assistência à Saúde/ética , Análise Ética , Prioridades em Saúde/ética , Nível de Saúde , Humanos , Princípios Morais
4.
Bioethics ; 35(2): 125-134, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33325536

RESUMO

In March 2020, the rapid increase in severe COVID-19 cases overwhelmed the healthcare systems in several European countries. The capacities for artificial ventilation in intensive care units were too scarce to care for patients with acute respiratory disorder connected to the disease. Several professional associations published COVID-19 triage recommendations in an extremely short time: in 21 days between March 6 and March 27. In this article, we compare recommendations from five European countries, which combine medical and ethical reflections on this situation in some detail. Our aim is to provide a detailed overview on the ethical elements of the recommendations, the differences between them and their coherence. In more general terms we want to identify shortcomings in regard to a common European response to the current situation.


Assuntos
/terapia , Alocação de Recursos para a Atenção à Saúde , Padrão de Cuidado/ética , Triagem/ética , Fatores Etários , Europa (Continente)/epidemiologia , Pessoal de Saúde/ética , Pessoal de Saúde/psicologia , Prioridades em Saúde , Hospitalização , Direitos Humanos , Humanos , Unidades de Terapia Intensiva/ética , Guias de Prática Clínica como Assunto , Resultado do Tratamento , Ventiladores Mecânicos/provisão & distribução , Suspensão de Tratamento/ética
5.
Front Public Health ; 8: 587423, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33363084

RESUMO

COVID-19 has overwhelmed healthcare systems across the globe with an unprecedented surge in the demand for hospitalizations. Consequently, many hospitals are facing precarious conditions due to limited capacity, especially in the provision of ventilators. The governing ethical principles of medical practice delineated in (1) favor prioritizing younger patients, largely because of their relatively higher expected life years. We conduct a survey of the general public in the United States to elicit their preferences for the allocation of a limited number of ventilators. The results show that the general public views align with the established ethical principles, which favor younger patients. JEL Classification: C91.


Assuntos
Alocação de Recursos para a Atenção à Saúde/ética , Hospitalização , Prognóstico , Alocação de Recursos , Triagem/ética , Adulto , Feminino , Humanos , Masculino , Anos de Vida Ajustados por Qualidade de Vida , Estados Unidos , Ventiladores Mecânicos/provisão & distribução
6.
BMC Med ; 18(1): 404, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33334347

RESUMO

BACKGROUND: The COVID-19 pandemic has placed sustained demand on health systems globally, and the capacity to provide critical care has been overwhelmed in some jurisdictions. It is unknown which triage criteria for allocation of resources perform best to inform health system decision-making. We sought to summarize and describe existing triage tools and ethical frameworks to aid healthcare decision-making during infectious disease outbreaks. METHODS: We conducted a rapid review of triage criteria and ethical frameworks for the allocation of critical care resources during epidemics and pandemics. We searched Medline, EMBASE, and SCOPUS from inception to November 3, 2020. Full-text screening and data abstraction were conducted independently and in duplicate by three reviewers. Articles were included if they were primary research, an adult critical care setting, and the framework described was related to an infectious disease outbreak. We summarized each triage tool and ethical guidelines or framework including their elements and operating characteristics using descriptive statistics. We assessed the quality of each article with applicable checklists tailored to each study design. RESULTS: From 11,539 unique citations, 697 full-text articles were reviewed and 83 articles were included. Fifty-nine described critical care triage protocols and 25 described ethical frameworks. Of these, four articles described both a protocol and ethical framework. Sixty articles described 52 unique triage criteria (29 algorithm-based, 23 point-based). Few algorithmic- or point-based triage protocols were good predictors of mortality with AUCs ranging from 0.51 (PMEWS) to 0.85 (admitting SOFA > 11). Most published triage protocols included the substantive values of duty to provide care, equity, stewardship and trust, and the procedural value of reason. CONCLUSIONS: This review summarizes available triage protocols and ethical guidelines to provide decision-makers with data to help select and tailor triage tools. Given the uncertainty about how the COVID-19 pandemic will progress and any future pandemics, jurisdictions should prepare by selecting and adapting a triage tool that works best for their circumstances.


Assuntos
Cuidados Críticos , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/métodos , Triagem/métodos , Surtos de Doenças , Humanos , Triagem/ética
7.
Rev. bioét. derecho ; (50): 37-61, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191345

RESUMO

Este documento ofrece una propuesta desde la perspectiva de la bioética para la elaboración de un protocolo de triaje en el contexto de la pandemia de COVID-19. Dicha propuesta incluye recomendaciones sobre las normas procedimentales y normas sustantivas que deben regir la asignación y reasignación de recursos terapéuticos en condiciones de escasez extrema


This document offers a proposal for the elaboration of a triage guideline in the context of the COVID-19 pandemic. This proposal includes recommendations on the procedural norms and substantive norms that should govern the allocation and reallocation of therapeutic resources in conditions of extreme scarcity


Aquest document ofereix una proposta des de la perspectiva de la bioètica per a l'elaboració d'un protocol de triatge en el context de la pandèmia de COVID-19. L'esmentada proposta inclou recomanacions sobre les normes procedimentals I normes substantives que han de regir l'assignació I reassignació de recursos terapèutics en condicions d'escassetat extrema


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias/ética , Protocolos Clínicos , Triagem/ética , Tomada de Decisões/ética
8.
J Infect Dev Ctries ; 14(9): 968-970, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-33031082

RESUMO

The COVID-19 pandemic has created new challenges on multiple fronts including a few ethical concerns. Timely and appropriate access to health services and the need to protect vulnerable people are some of them. An important aspect to consider, at the global level, is the frailty of health systems in many developing countries and the constant threat of these collapsing due to shortage of resources and medical supply. Special attention should be placed towards protecting the health of care workers who are highly exposed to SARS-CoV-2 infection. Research and clinical trials involving COVID-19 patients and healthy human volunteers must be done in strict adherence to the fundamental principles of bioethics, even if finding a solution is an urgent need. Shared responsibility must be assumed as we collectively face a common problem and ethical conflicts must be resolved using, as reference, the guidelines developed by the World Health Organization and other relevant international and national organizations. This would allow responsible action in the face of the pandemic without harming human rights, the individual and collective well-being.


Assuntos
Betacoronavirus , Saúde Global/ética , Pandemias/ética , Ensaios Clínicos como Assunto/ética , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Países em Desenvolvimento , Pessoal de Saúde/ética , Disparidades em Assistência à Saúde/ética , Direitos Humanos/ética , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Triagem/ética
9.
S Afr Med J ; 110(7): 625-628, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32880336

RESUMO

The COVID-19 pandemic has brought discussions around the appropriate and fair rationing of scare resources to the forefront. This is of special importance in a country such as South Africa (SA), where scarce resources interface with high levels of need. A large proportion of the SA population has risk factors associated with worse COVID-19 outcomes. Many people are also potentially medically and socially vulnerable secondary to the high levels of infection with HIV and tuberculosis (TB) in the country. This is the second of two articles. The first examined the clinical evidence regarding the inclusion of HIV and TB as comorbidities relevant to intensive care unit (ICU) admission triage criteria. Given the fact that patients with HIV or TB may potentially be excluded from admission to an ICU on the basis of an assumption of lack of clinical suitability for critical care, in this article we explore the ethicolegal implications of limiting ICU access of persons living with HIV or TB. We argue that all allocation and rationing decisions must be in terms of SA law, which prohibits unfair discrimination. In addition, ethical decision-making demands accurate and evidence-based strategies for the fair distribution of limited resources. Rationing decisions and processes should be fair and based on visible and consistent criteria that can be subjected to objective scrutiny, with the ultimate aim of ensuring accountability, equity and fairness.


Assuntos
Infecções por Coronavirus , Infecções por HIV/epidemiologia , Alocação de Recursos para a Atenção à Saúde/métodos , Unidades de Terapia Intensiva , Pandemias , Seleção de Pacientes/ética , Pneumonia Viral , Alocação de Recursos , Triagem , Tuberculose/epidemiologia , Betacoronavirus/isolamento & purificação , Coinfecção , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/normas , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Alocação de Recursos/ética , Alocação de Recursos/legislação & jurisprudência , África do Sul/epidemiologia , Triagem/economia , Triagem/ética , Triagem/legislação & jurisprudência
10.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 106-111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965367

RESUMO

The respiratory disease caused by the coronavirus SARS-CoV-2 (COVID-19) is a pandemic that produces a large number of simultaneous patients with severe symptoms and in need of special hospital care, overloading the infrastructure of health services. All of these demands generate the need to ration equipment and interventions. Faced with this imbalance, how, when, and who decides, there is the impact of the stressful systems of professionals who are at the front line of care and, in the background, issues inherent to human subjectivity. Along this path, the idea of using artificial intelligence algorithms to replace health professionals in the decision-making process also arises. In this context, there is the ethical question of how to manage the demands produced by the pandemic. The objective of this work is to reflect, from the point of view of medical ethics, on the basic principles of the choices made by the health teams, during the COVID-19 pandemic, whose resources are scarce and decisions cause anguish and restlessness. The ethical values for the rationing of health resources in an epidemic must converge to some proposals based on fundamental values such as maximizing the benefits produced by scarce resources, treating people equally, promoting and recommending instrumental values, giving priority to critical situations. Naturally, different judgments will occur in different circumstances, but transparency is essential to ensure public trust. In this way, it is possible to develop prioritization guidelines using well-defined values and ethical recommendations to achieve fair resource allocation.


Assuntos
Tomada de Decisão Clínica/ética , Infecções por Coronavirus/epidemiologia , Alocação de Recursos para a Atenção à Saúde/ética , Pandemias , Pneumonia Viral/epidemiologia , Triagem/ética , Inteligência Artificial , Betacoronavirus , Infecções por Coronavirus/terapia , Humanos , Pneumonia Viral/terapia , Ventiladores Mecânicos/provisão & distribução
11.
J Clin Ethics ; 31(4): 303-317, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991327

RESUMO

The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the triage protocol, summarize the protocol itself, and discuss the major ethical challenges encountered, along with our answers to these challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments. We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges that they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the COVID-19 pandemic and similar public health emergencies.


Assuntos
Alocação de Recursos para a Atenção à Saúde/ética , Recursos em Saúde/provisão & distribução , Pandemias/ética , Triagem/ética , Betacoronavirus , Criança , Infecções por Coronavirus , Emergências , Feminino , Humanos , Pneumonia Viral , Gravidez , Saúde Pública
14.
Cuad Bioet ; 31(102): 183-202, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32910671

RESUMO

The article deals with the analysis of the criteria for the allocation of scarce health resources during the pandemic produced by the COVID 19 virus in Spain. It critically analyses the absence of a legal-constitutional perspective in the elaboration of such criteria and suggests the incorporation of the criterion of equity as a guarantee of the effective exercise of the constitutional right to health protection by vulnerable persons.


Assuntos
Betacoronavirus , Recursos em Saúde/ética , Pandemias/ética , Alocação de Recursos/ética , Constituição e Estatutos , Infecções por Coronavirus/prevenção & controle , Teoria Ética , Órgãos Governamentais , Prioridades em Saúde , Recursos em Saúde/legislação & jurisprudência , Recursos em Saúde/provisão & distribução , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/legislação & jurisprudência , Direitos Humanos/legislação & jurisprudência , Humanos , Grupos Minoritários , Pandemias/legislação & jurisprudência , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Publicações , Alocação de Recursos/legislação & jurisprudência , Papel (figurativo) , Justiça Social , Sociedades Médicas , Espanha/epidemiologia , Triagem/ética , Populações Vulneráveis
19.
S Afr Med J ; 110(5): 355-359, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32657716

RESUMO

Since the World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern, COVID-19 infection and the associated mortality have increased exponentially, globally. South Africa (SA) is no exception. Concerns abound over whether SA's healthcare system can withstand a demand for care that is disproportionate to current resources, both in the state and private health sectors. While healthcare professionals in SA have become resilient and adept at making difficult decisions in the face of resource limitations, a surge in COVID-19 cases could place a severe strain on the country's critical care services and necessitate unprecedented rationing decisions. This could occur at two critical points: access to ventilation, and withdrawal of intensive care in non- responsive or deteriorating cases. The ethical dimensions of decision-making at both junctures merit urgent consideration.


Assuntos
Infecções por Coronavirus , Cuidados Críticos , Serviço Hospitalar de Emergência/organização & administração , Alocação de Recursos para a Atenção à Saúde/tendências , Pandemias , Pneumonia Viral , Alocação de Recursos , Triagem , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Cuidados Críticos/ética , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Emergências/epidemiologia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Alocação de Recursos/ética , Alocação de Recursos/organização & administração , África do Sul/epidemiologia , Triagem/ética , Triagem/organização & administração , Ventiladores Mecânicos/provisão & distribução
20.
AIDS Rev ; 22(2): 123-124, 2020 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-32628222

RESUMO

The unprecedented COVID-19 pandemic has risen a number of clinical situations where the principles of the medical act, the singularity of the patient-physician relationship and the need for revitalizing the medical vocation have all become at front line. Original articles, viewpoints, and perspectives addressing these aspects have appeared in major medical journals. Never before but perhaps with AIDS in the eighties, a disease awakened such feelings of commitment in medicine. Herein, we discuss some of these very sensitive issues for physicians that emerged during the past months of global COVID-19 crisis.


Assuntos
Tomada de Decisão Clínica/ética , Alocação de Recursos para a Atenção à Saúde/ética , Pandemias/ética , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Ética Médica , Humanos , Unidades de Terapia Intensiva , Casas de Saúde , Papel do Médico , Relações Médico-Paciente , Médicos/ética , Médicos/psicologia , Pneumonia Viral/epidemiologia , Respiração Artificial , Identificação Social , Estresse Psicológico/psicologia , Triagem/ética
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