Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions.
Identifieur interne : 001826 ( PubMed/Curation ); précédent : 001825; suivant : 001827Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions.
Auteurs : Douglas B. White [États-Unis] ; Mitchell H. Katz ; John M. Luce ; Bernard LoSource :
- Annals of internal medicine [ 1539-3704 ] ; 2009.
Descripteurs français
- KwdFr :
- MESH :
- ressources et distribution : Respirateurs artificiels.
- éthique : Rationnement des services de santé.
- Flambées de maladies, Grippe humaine, Humains, Prise de décision, Santé publique, Urgences, Valeur de la vie, Valeurs sociales.
English descriptors
- KwdEn :
- MESH :
- ethics : Health Care Rationing.
- supply & distribution : Ventilators, Mechanical.
- therapy : Influenza, Human.
- Decision Making, Disease Outbreaks, Emergencies, Humans, Public Health, Social Values, Value of Life.
Abstract
A public health emergency, such as an influenza pandemic, will lead to shortages of mechanical ventilators, critical care beds, and other potentially life-saving treatments. Difficult decisions about who will and will not receive these scarce resources will have to be made. Existing recommendations reflect a narrow utilitarian perspective, in which allocation decisions are based primarily on patients' chances of survival to hospital discharge. Certain patient groups, such as the elderly and those with functional impairment, are denied access to potentially life-saving treatments on the basis of additional allocation criteria. We analyze the ethical principles that could guide allocation and propose an allocation strategy that incorporates and balances multiple morally relevant considerations, including saving the most lives, maximizing the number of "life-years" saved, and prioritizing patients who have had the least chance to live through life's stages. We also argue that these principles are relevant to all patients and therefore should be applied to all patients, rather than selectively to the elderly, those with functional impairment, and those with certain chronic conditions. We discuss strategies to engage the public in setting the priorities that will guide allocation of scarce life-sustaining treatments during a public health emergency.
DOI: 10.7326/0003-4819-150-2-200901200-00011
PubMed: 19153413
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Katz</name></author><author><name sortKey="Luce, John M" sort="Luce, John M" uniqKey="Luce J" first="John M" last="Luce">John M. Luce</name></author><author><name sortKey="Lo, Bernard" sort="Lo, Bernard" uniqKey="Lo B" first="Bernard" last="Lo">Bernard Lo</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2009">2009</date><idno type="RBID">pubmed:19153413</idno><idno type="pmid">19153413</idno><idno type="doi">10.7326/0003-4819-150-2-200901200-00011</idno><idno type="wicri:Area/PubMed/Corpus">001826</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">001826</idno><idno type="wicri:Area/PubMed/Curation">001826</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">001826</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Who should receive life support during a public health emergency? 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Luce</name></author><author><name sortKey="Lo, Bernard" sort="Lo, Bernard" uniqKey="Lo B" first="Bernard" last="Lo">Bernard Lo</name></author></analytic><series><title level="j">Annals of internal medicine</title><idno type="eISSN">1539-3704</idno><imprint><date when="2009" type="published">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Decision Making</term><term>Disease Outbreaks</term><term>Emergencies</term><term>Health Care Rationing (ethics)</term><term>Humans</term><term>Influenza, Human (therapy)</term><term>Public Health</term><term>Social Values</term><term>Value of Life</term><term>Ventilators, Mechanical (supply & distribution)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Flambées de maladies</term><term>Grippe humaine ()</term><term>Humains</term><term>Prise de décision</term><term>Rationnement des services de santé (éthique)</term><term>Respirateurs artificiels (ressources et distribution)</term><term>Santé publique</term><term>Urgences</term><term>Valeur de la vie</term><term>Valeurs sociales</term></keywords><keywords scheme="MESH" qualifier="ethics" xml:lang="en"><term>Health Care Rationing</term></keywords><keywords scheme="MESH" qualifier="ressources et distribution" xml:lang="fr"><term>Respirateurs artificiels</term></keywords><keywords scheme="MESH" qualifier="supply & distribution" xml:lang="en"><term>Ventilators, Mechanical</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="éthique" xml:lang="fr"><term>Rationnement des services de santé</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Decision Making</term><term>Disease Outbreaks</term><term>Emergencies</term><term>Humans</term><term>Public Health</term><term>Social Values</term><term>Value of Life</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Flambées de maladies</term><term>Grippe humaine</term><term>Humains</term><term>Prise de décision</term><term>Santé publique</term><term>Urgences</term><term>Valeur de la vie</term><term>Valeurs sociales</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">A public health emergency, such as an influenza pandemic, will lead to shortages of mechanical ventilators, critical care beds, and other potentially life-saving treatments. Difficult decisions about who will and will not receive these scarce resources will have to be made. Existing recommendations reflect a narrow utilitarian perspective, in which allocation decisions are based primarily on patients' chances of survival to hospital discharge. Certain patient groups, such as the elderly and those with functional impairment, are denied access to potentially life-saving treatments on the basis of additional allocation criteria. We analyze the ethical principles that could guide allocation and propose an allocation strategy that incorporates and balances multiple morally relevant considerations, including saving the most lives, maximizing the number of "life-years" saved, and prioritizing patients who have had the least chance to live through life's stages. We also argue that these principles are relevant to all patients and therefore should be applied to all patients, rather than selectively to the elderly, those with functional impairment, and those with certain chronic conditions. We discuss strategies to engage the public in setting the priorities that will guide allocation of scarce life-sustaining treatments during a public health emergency.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">19153413</PMID><DateCompleted><Year>2009</Year><Month>02</Month><Day>06</Day></DateCompleted><DateRevised><Year>2019</Year><Month>06</Month><Day>19</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1539-3704</ISSN><JournalIssue CitedMedium="Internet"><Volume>150</Volume><Issue>2</Issue><PubDate><Year>2009</Year><Month>Jan</Month><Day>20</Day></PubDate></JournalIssue><Title>Annals of internal medicine</Title><ISOAbbreviation>Ann. Intern. Med.</ISOAbbreviation></Journal><ArticleTitle>Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions.</ArticleTitle><Pagination><MedlinePgn>132-8</MedlinePgn></Pagination><Abstract><AbstractText>A public health emergency, such as an influenza pandemic, will lead to shortages of mechanical ventilators, critical care beds, and other potentially life-saving treatments. Difficult decisions about who will and will not receive these scarce resources will have to be made. Existing recommendations reflect a narrow utilitarian perspective, in which allocation decisions are based primarily on patients' chances of survival to hospital discharge. Certain patient groups, such as the elderly and those with functional impairment, are denied access to potentially life-saving treatments on the basis of additional allocation criteria. We analyze the ethical principles that could guide allocation and propose an allocation strategy that incorporates and balances multiple morally relevant considerations, including saving the most lives, maximizing the number of "life-years" saved, and prioritizing patients who have had the least chance to live through life's stages. We also argue that these principles are relevant to all patients and therefore should be applied to all patients, rather than selectively to the elderly, those with functional impairment, and those with certain chronic conditions. We discuss strategies to engage the public in setting the priorities that will guide allocation of scarce life-sustaining treatments during a public health emergency.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>White</LastName><ForeName>Douglas B</ForeName><Initials>DB</Initials><AffiliationInfo><Affiliation>Program in Medical Ethics, School of Medicine, University of California-San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143-0903, USA. dwhite@medicine.ucsf.edu</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Katz</LastName><ForeName>Mitchell H</ForeName><Initials>MH</Initials></Author><Author ValidYN="Y"><LastName>Luce</LastName><ForeName>John M</ForeName><Initials>JM</Initials></Author><Author ValidYN="Y"><LastName>Lo</LastName><ForeName>Bernard</ForeName><Initials>B</Initials></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>K23 AG032875</GrantID><Acronym>AG</Acronym><Agency>NIA NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>K23 AG032875-01</GrantID><Acronym>AG</Acronym><Agency>NIA NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>KL2 RR024130</GrantID><Acronym>RR</Acronym><Agency>NCRR NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>KL2 RR 024130</GrantID><Acronym>RR</Acronym><Agency>NCRR NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D052061">Research Support, N.I.H., Extramural</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Ann Intern Med</MedlineTA><NlmUniqueID>0372351</NlmUniqueID><ISSNLinking>0003-4819</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Ann Intern Med. 2009 Jun 16;150(12):889-90; author reply 891-2</RefSource><PMID Version="1">19528570</PMID></CommentsCorrections><CommentsCorrections RefType="CommentIn"><RefSource>Ann Intern Med. 2009 Jun 16;150(12):889; author reply 891-2</RefSource><PMID Version="1">19528571</PMID></CommentsCorrections><CommentsCorrections RefType="CommentIn"><RefSource>Ann Intern Med. 2009 Jun 16;150(12):889; author reply 891-2</RefSource><PMID Version="1">19528572</PMID></CommentsCorrections><CommentsCorrections RefType="CommentIn"><RefSource>Ann Intern Med. 2009 Jun 16;150(12):890-1; author reply 891-2</RefSource><PMID Version="1">19528573</PMID></CommentsCorrections><CommentsCorrections RefType="CommentIn"><RefSource>Ann Intern Med. 2009 Jun 16;150(12):890; author reply 891-2</RefSource><PMID Version="1">19528574</PMID></CommentsCorrections><CommentsCorrections RefType="CommentIn"><RefSource>Indian J Med Ethics. 2010 Jul-Sep;7(3):183-4</RefSource><PMID Version="1">20806534</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D003657" MajorTopicYN="Y">Decision Making</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004196" MajorTopicYN="N">Disease Outbreaks</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004630" MajorTopicYN="Y">Emergencies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015276" MajorTopicYN="N">Health Care Rationing</DescriptorName><QualifierName UI="Q000941" MajorTopicYN="Y">ethics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007251" MajorTopicYN="N">Influenza, Human</DescriptorName><QualifierName 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