The shared ethical framework to allocate scarce medical resources: a lesson from COVID-19
Durant la pandèmia i des d'aquest blog he parlat repetidament dels principis ètics en l'assignació de recursos. Ara l'Ezequiel Emanuel i en Govind Persad des del Lancet fan un article de resum imprescindible. I diuen:
The ethical allocation of scarce medical resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using the values to delineate priority tiers for scarce resources, and (3) actually implementing the prioritisation to faithfully realise the fundamental values. The COVID-19 pandemic engendered many assessments and reports on the ethical allocation of vaccines, therapeutics, and other medical interventions that have elucidated the definitive ethical framework for distributing scarce resources. The pandemic also provided major tests for implementing ethical allocation frameworks, revealing important lessons on the challenges of moving from theory to practice, and refinements that would enhance realisation of the ethical framework
I després d'explicar els tres passos, mostren quins són els valors fonamentals per assignar recursos mèdics escassos en aquesta taua:
Table 2Fundamental values for allocating scarce medical resources
| Definition | |
|---|---|
| Maximising benefits and preventing harm | Preferential allocation of medical resources towards individuals who can gain most benefit and protection against harm; harms can be broad to include both health (eg, death) and non-health (eg, poverty); harms can occur directly from the disease and indirectly when health-care system functioning is compromised |
| Mitigating disadvantage | Preferential allocation of medical resources towards people who are disadvantaged by income, race, ethnicity, religion, or other characteristics |
| Equal moral concern | Treating similar people similarly, and not discriminating on the basis of morally irrelevant characteristics such as race, ethnicity, or religion; typically requires not treating people the same, but treating people in different circumstances (eg, in communities with a higher or lower burden of COVID-19) differently |
| Reciprocity | Preferential allocation of medical resources towards people, communities, or countries who in the past took on burdens to address the current health problem |
| Instrumental value | Preferential allocation of medical resources towards people who will be able to mitigate harms and disadvantage of others; not an independent value but facilitates realising the other values particularly benefitting people |
I després entren en detalls de documents que han tractat la qüestió, i alhora els reptes en la seva aplicació pràctica, i conclouen:
The lessons learned clarify that the ethical framework to guide allocation entails five substantive values—minimising harms, mitigating disadvantage (ensuring equity), equal moral concern (not identical treatment), reciprocity, and instrumental value. The pandemic also helped to clarify the establishment of priority tiers that primarily emphasise instrumental value, minimising harm, and mitigating disadvantage.
Article de referència, per guardar.
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