SAOPŠTENJE Pravičnosti etičkih odluka u odnosu raspodele medicinskih resursa unutar pandemije COVID-19

  • Violetta Raffay
  • Aleksandra Lazić Klinički Centar Vojvodine - Urgentni centar
  • zlatko Fiser Resuscitacioni Savet Srbije
Ključne reči: COVID -19, kardiopulmonalna resuscitacija, etika tokom resuscitacije

Sažetak


Resuscitacioni Savet Srbije je razmatrao i doneo konsenzus mišljenja nacionalnih kurs direktora oblasti resuscitacione medicine o osnovnim principima raspodele resursa, a u odnosu na primenu mera resuscitacije i zbrinjavanje obolelih u uslovima pandemije,

COVID-19 pandemija je širom sveta unutar svih segmenta života donela dosta promena, svakodnevnih izazova sa kojima se suočavamo, pa tako i u oblasti medicinske etike, koja je vrlo osetljiva oblast zbog specifičnosti koje su jedinstvene i različite u svakoj zemlji pojedinačno, uz snažne kulturološke, ekonomske, verske, medicinske, pravne i ostale diverzitete.

Izazovi su ogromni, obzirom na trenutno nepostojanje specifične terapije, ograničenost raspoloživih resursa dijagnostike, intervencije i preventivnih mera.

Pandemija je donela i potrebu stvaranja uslova primene „nesvakidašnjih“ zahteva, mera i procedura zdravstvenog sistema i medicinskog zbrinjavanja, koja za sobom povlači i određenu reorganizaciju medicinskih intervencija i sistema zbrinjavanja, uključujući i mere obavezne lične zaštite, pridržavanje primerene socijalne distance i sve higijenske procedure.

Sveopšti etički principi, kao što su maksimalni benefit i podjednakost lečenja, uz davanje prioriteta onima sa najtežim stanjem je stvorilo potrebu stvaranja preporuka u etici koje su vezane za raspodelu medicinskih resusrsa u COVID-19 pandemiji, te su Eziekel et al. objavili šest načela koja se odnose na gore pomenuto u smislu: maksimalizovanje benefita, davanja prednosti zdravstvenim radnicima, trijaža van okvira osnove “prvog stizanja”, reagovanja na nalaze, prepoznavanje učešća u istraživanjima, te primenu istovetnih principa kako kod COVID-19, tako i kod non-COVID-19 pacijenata

Reference

Emanuel EJ, Persad G, Upshur R, et al. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med. 2020;382(21):2049-2055. doi:10.1056/NEJMsb2005114
Persad G, Wertheimer A, Emanuel EJ. Principles for allocation of scarce medical interventions. Lancet 2009;373:423-431.
Emanuel EJ, Wertheimer A. Public health: who should get influenza vaccine when not all can? Science 2006;312:854-855.
Biddison LD, Berkowitz KA, Courtney B, et al. Ethical considerations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2014;146:4 Suppl:e145S-e155S.
Christian MD, Sprung CL, King MA, et al. Triage: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2014;146:4 Suppl:e61S-e74S.
Responding to pandemic influenza — the ethical framework for policy and planning. London: UK Department of Health, 2007 (https://webarchive.nationalarchives.gov.uk/20130105020420/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_080729.pdf).
Toner E, Waldhorn R. What US hospitals should do now to prepare for a COVID-19 pandemic. Baltimore: Johns Hopkins University Center for Health Security, 2020 (http://www.centerforhealthsecurity.org/cbn/2020/cbnreport-02272020.html).
Influenza pandemic — providing critical care. North Sydney, Australia: Ministry of Health, NSW, 2010 (https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2010_028.pdf).
Vergano M, Bertolini G, Giannini A, et al. Clinical Ethics Recommendations for the Allocation of Intensive Care Treatments, in Exceptional, Resource-Limited Circumstances. Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI). March 16, 2020 (http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI/SIAARTI%20-%20Covid-19%20-%20Clinical%20Ethics%20Reccomendations.pdf).
Rosenbaum SJ, Bayer R, Bernheim RG, et al. Ethical considerations for decision making regarding allocation of mechanical ventilators during a severe influenza pandemic or other public health emergency. Atlanta: Centers for Disease Control and Prevention, 2011 (https://www.cdc.gov/od/science/integrity/phethics/docs/Vent_Document_Final_Version.pdf).
Kerstein SJ. Dignity, disability, and lifespan. J Appl Philos 2017;34:635-650.
Hick JL, Hanfling D, Wynia MK, Pavia AT. Duty to plan: health care, crisis standards of care, and novel coronavirus SARS-CoV-2. NAM Perspectives. March 5, 2020 (https://nam.edu/duty-to-plan-health-care-crisis-standards-of-care-and-novel-coronavirus-sars-cov-2/).
Interim updated planning guidance on allocating and targeting pandemic influenza vaccine during an influenza pandemic. Atlanta: Centers for Disease Control and Prevention, 2018 (https://www.cdc.gov/flu/pandemic-resources/national-strategy/planning-guidance/index.html).
Irvin CB, Cindrich L, Patterson W, Southall A. Survey of hospital healthcare personnel response during a potential avian influenza pandemic: will they come to work? Prehosp Disaster Med 2008;23:328-335.
Biesecker M, Smith MR, Reynolds T. Celebrities get virus tests, raising concerns of inequality. Associated Press. March 19, 2020 (https://apnews.com/b8dcd1b369001d5a70eccdb1f75ea4bd).
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020 February 24
Updated guidance on evaluating and testing persons for coronavirus disease 2019 (COVID-19). Atlanta: Centers for Disease Control and Prevention, March 8, 2020 (https://emergency.cdc.gov/han/2020/han00429.asp.)
COVID-19 sentinel surveillance. Honolulu: State of Hawaii Department of Health, 2020 (https://health.hawaii.gov/docd/covid-19-sentinel-surveillance/).
Mounk Y. The extraordinary decisions facing Italian doctors. Atlantic. March 11, 2020 (https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/).
Zucker H, Adler K, Berens D, et al. Ventilator allocation guidelines. Albany: New York State Department of Health Task Force on Life and the Law, November 2015 (https://www.health.ny.gov/regulations/task_force/reports_publications/docs/ventilator_guidelines.pdf).
Objavljeno
2020/12/01
Kako citirati
RaffayV., LazićA., & Fiser zlatko. (2020). SAOPŠTENJE Pravičnosti etičkih odluka u odnosu raspodele medicinskih resursa unutar pandemije COVID-19. Journal Resuscitatio Balcanica, 6(16), 254 - 260. https://doi.org/10.5937/jrb6-28318
Rubrika
Članci