Recommendations on COVID‐19 triage: international comparison and ethical analysis

On March 11, 2020 the World Health Organization classified COVID‐19, caused by Sars‐CoV‐2, as a pandemic. Although not much was known about the new virus, the first outbreaks in China and Italy showed that potentially a large number of people worldwide could fall critically ill in a short period of...

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Vydáno v:Bioethics Ročník 34; číslo 9; s. 948 - 959
Hlavní autoři: Jöbges, Susanne, Vinay, Rasita, Luyckx, Valerie A., Biller‐Andorno, Nikola
Médium: Journal Article
Jazyk:angličtina
Vydáno: England Blackwell Publishing Ltd 01.11.2020
John Wiley and Sons Inc
Témata:
Asia
Australasia
Canada
Comparative analysis
comparison
COVID-19
COVID-19 - therapy
Critical Care
Critical Illness
Deaths
Decision making
Decision Making - ethics
Ethical Analysis
Ethics
Europe
guidelines
Health care
Health Care Rationing - ethics
Health Resources
Health services
Humans
Influenza
Intensive care
International comparisons
Medical ethics
Medical prognosis
Medicine
Pandemics
Pandemics - ethics
Policy making
Practice Guidelines as Topic
Prognosis
Psychosocial factors
Psychosocial support
Public health
Resource allocation
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Social Justice
Societies, Medical
South Africa
Transparency
Triage
Triage - ethics
Ventilators
Canada
South Africa
Asia
Australasia
Europe
Italy
COVID-19
guidelines
comparison
ethics
triage
public health
ISSN:0269-9702, 1467-8519, 1467-8519
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Shrnutí:On March 11, 2020 the World Health Organization classified COVID‐19, caused by Sars‐CoV‐2, as a pandemic. Although not much was known about the new virus, the first outbreaks in China and Italy showed that potentially a large number of people worldwide could fall critically ill in a short period of time. A shortage of ventilators and intensive care resources was expected in many countries, leading to concerns about restrictions of medical care and preventable deaths. In order to be prepared for this challenging situation, national triage guidance has been developed or adapted from former influenza pandemic guidelines in an increasing number of countries over the past few months. In this article, we provide a comparative analysis of triage recommendations from selected national and international professional societies, including Australia/New Zealand, Belgium, Canada, Germany, Great Britain, Italy, Pakistan, South Africa, Switzerland, the United States, and the International Society of Critical Care Medicine. We describe areas of consensus, including the importance of prognosis, patient will, transparency of the decision‐making process, and psychosocial support for staff, as well as the role of justice and benefit maximization as core principles. We then probe areas of disagreement, such as the role of survival versus outcome, long‐term versus short‐term prognosis, the use of age and comorbidities as triage criteria, priority groups and potential tiebreakers such as ‘lottery’ or ‘first come, first served’. Having explored a number of tensions in current guidance, we conclude with a suggestion for framework conditions that are clear, consistent and implementable. This analysis is intended to advance the ongoing debate regarding the fair allocation of limited resources and may be relevant for future policy‐making.
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ISSN:0269-9702
1467-8519
1467-8519
DOI:10.1111/bioe.12805