美国医院正在为谁应该优先获得治疗而制定方案

美国医院正在为谁应该优先获得治疗而制定方案

As COVID-19 spreads rapidly through the United States, many American doctors could soon be making the decisions that overwhelmed health care workers in Italy are already facing: Which patients get lifesaving treatment, and which ones do not?

随着COVID-19在美国的迅速传播，许多美国医生可能很快就会做出早已让意大利医护人员不知所措的决定:哪些病人会得到挽救生命的治疗，哪些病人不会得到?

Every accredited hospital in the U.S. is required to have some mechanism for addressing ethical issues like this — typically, an ethics committee made up of not just medical professionals but often also social workers, pastors and patient advocates. Sometimes in partnership with hospital triage committees, they create guidelines for prioritizing patient care if there's a resource shortage.

在美国，每一家获得认证的医院都被要求有某种机制来处理这样的伦理问题——通常情况下，一个伦理委员会不仅由医学专业人士组成，而且通常还包括社会工作者、牧师和患者维权人士。有时，他们与医院的分类委员会合作，制定出在资源短缺时优先照顾病人的指导方针。

As the number of coronavirus cases rises in the U.S., hospitals have a new urgency in revisiting and updating those guidelines.

随着美国冠状病毒病例数量的增加，医院在重新审视和更新这些指南方面有了新的紧迫性。

They vary from hospital to hospital, but their overall goal is usually to save the most lives. So hospitals consider a combination of factors: age, life expectancy, how severe a patient's illness is, how likely treatment is to help and whether a patient has additional illnesses that could shorten the person's life span, such as cancer or heart disease. Hospitals can then use those factors to develop scoring systems or clinical scores to prioritize care.

每个医院的情况各不相同，但他们的总体目标通常是挽救最多的生命。因此，医院会综合考虑以下因素：年龄、预期寿命、患者病情有多严重、治疗有多大可能有帮助，以及患者是否患有其他可能缩短其寿命的疾病，如癌症或心脏病。然后，医院可以利用这些因素来开发评分系统或临床评分，以优先护理。

In early March, as the coronavirus outbreak worsened in Italy, an Italian medical association issued guidelines finding that doctors might have to prioritize younger COVID-19 patients over older ones. "It may be necessary to place an age limit" on access to intensive care, the guidelines advised, with the goal of preserving limited health care resources for patients more likely to survive.

3月初，随着意大利冠状病毒疫情的恶化，意大利一家医学协会发布了一项指导方针，指出医生可能必须优先考虑年轻的COVID-19患者，而不是老年患者。”指导方针建议，可能有必要对“获得重症监护的机会”设定年龄限制，以期为更有可能存活的患者保留有限的医疗资源。

But age is rarely the only factor in such decision-making. For example, a 20-year-old will not always get priority over a 60-year-old, especially if that 20-year-old has additional health problems that could mean the 60-year-old is likely to live longer anyway. Scoring systems can disadvantage older patients, because as people age they become more susceptible to disease, which can hurt their clinical scores.

但年龄很少是做决定的唯一因素。例如，一个20岁的人并不总是比60岁的人更有优先权，特别是如果这个20岁的人有额外的健康问题，这可能意味着60岁的人无论如何都可能活得更长。评分系统可能对老年患者不利，因为随着年龄的增长，他们更容易患病，这可能会影响他们的临床评分。

Another potential factor is "social usefulness," a concept that might favor, for example, a sick nurse because that person could go on to save other lives.

另一个潜在的因素是“社会有用性”，这个概念可能有利于，例如，一个生病的护士，因为这个人可以继续拯救其他人的生命。

"Some people think that people who are in a position to help address a crisis in the future if they were to recover, like health care workers and first responders, maybe should receive some sort of priority in triaging scarce resources," said Emily Rubin, a pulmonary and critical care physician at Massachusetts General Hospital in Boston and a co-chair of the hospital's ethics committee.

埃米莉·鲁宾说：“有些人认为，像医疗工作者和急救人员一样，如果他们能够康复，有能力帮助解决未来危机的人，也许应该在筛选稀缺资源方面获得某种优先权，波士顿马萨诸塞州总医院的一名肺和危重病护理医生，也是该医院伦理委员会的联合主席。

Wynia said most hospitals should operate on the principle that every human life has equal worth, so patients are clinically evaluated the same regardless of their employment, gender, race or insurance, or whether they have children.

怀尼亚说，大多数医院都应该按照每个人的生命都有同等价值的原则来运作，因此不管患者的就业、性别、种族或保险，也不管他们是否有孩子，临床评估都是一样的。

Hospitals could adopt a lottery or first-come-first-served system for triaging patients, but that might mean someone less sick is treated before someone more sick, potentially failing to achieve the goal of saving the most lives. Hospitals could treat worse-off patients first, but if those people are unlikely to survive, doctors might be better off focusing on people who are less ill.

医院可以采用抽签或先到先得的制度来对病人进行分类，但这可能意味着，病情较轻的病人会在病情较重的病人之前得到治疗，这可能无法达到挽救最多生命的目标。医院可以先治疗病情较重的病人，但如果这些病人不太可能活下来，医生最好还是关注病情较轻的病人。