纽约州为了应对类似意大利当下医疗资源短缺的情形，特别制定了医疗资源短缺时期的资源分配指导意见。Vice News采访参与制定该指导意见的Tia Powell医生，询问制定这份指导意见的初衷以及具体的分配细节：为什么不让临床医师自己决定？
再来看一看，华尔街日报记者带来的进一步深度报道。
– We have a real equipment problem the way we needed missiles in world wars,
we need ventilators.
– New York State is preparing its guidance for doctors and
hospitals on how to make some difficult decisions about patient care that they
may soon face. New York’s governor, Andrew Cuomo, says the state has about 5,000
ventilators but needs 30,000. Ventilators are machines that aid breathing. Many
critically ill coronavirus patients, like those with pneumonia, need the
assistance to survive. So, if and when hospitals run out of ventilators, how
would they decide which patients take priority?
– Doctors want guidance. Samuel
Gorovitz is a philosophy professor and longtime member of the New York State
Task Force on Life and the Law. In 2015, a group of experts on behalf of New
York State created guidelines for allocating ventilators should there be a
shortage of them in a flu pandemic. Gorovitz says he’s seen a draft of the
guidance the state is developing for ventilator allocation during a coronavirus
crisis. He says the draft he saw may be different from the final version. New
York’s Department of Health says that, “While the department has sought input
“from a variety of medical and ethics experts, “there is no expectation of a
formal report.”
– The guidance that is being developed and I believe soon will
be promulgated within New York State will indicate that there will have to be
… committees, triage committees, that will be required to contain
representation of ethical perspectives.
– [Jason] Triage committees were a key
part of the 2015 guidelines, tasked, among other things, with determining a
patient’s level of access to a ventilator.
– There will be committees that will
be involved in making the tragic triaging decisions … in situations in which
somebody who needs a ventilator will be denied access, or perhaps somebody on a
ventilator, for whom the prospects are essentially hopeless, will have to be
removed to make room for somebody else for whom the prospects are very much
better.
– So this committee would be in power to take a ventilator away from
someone who’s alive who probably won’t live, but he’s still alive, take them off
life support so they can give it to someone else?
– That’s what is going to
happen.
– [Jason] The 2015 guidelines say there may be scenarios in which the
triage committee must remove a ventilator from a patient whose health is not
improving.
– The idea would be the critical care team would say, “Here’s the
decision we believe we have to make, “and here’s the reason why, “and we’re
running that by a triage review team for vetting. “And are we leaving out
anything, are we missing anything? “Is there any consideration “that you would
call to our attention?” And the team might say, “Yeah, you’re failing to take
“into account thus and such,” or, “You’ve misses that.” Or the committee might
say, “That seems like a heartbreaking but justified choice.” And the critical
care doc at that point would be empowered to proceed.
– [Jason] Gorovitz says he
expects that family members of the patient whose ventilator is set to be removed
would be informed beforehand.
– You, the family member, might at that point say,
“I will not accept this.” You would then be told, if it’s as I expect, “You have
a right of appeal.” But this all will play out on a scale of minute, not hours.
– [Jason] In the 2015 guidelines, appeals are limited to so-called technical
injustices, like for example a withdrawal decision being made without
considering all triage criteria.
– If it’s a hospital system, they might be able
to have a committee that would look over several hospitals.
– [Jason] Dr. Tia
Powell helped leading the working group that wrote the original guidance
document in 2007. – In working on guidelines like this, I never ever thought we
would get there. And now, it definitely is a realistic possibility.
– [Jason]
Dr. Powell says that, within the past week, she too has read a draft of the
guidance New York State is preparing.
– These crisis standards of care, which
are radically different than what we do normally, would temporarily make it
possible to say, “We’re so sorry, we tried to pull you through, “it didn’t work,
and now we’re going “to remove that ventilator, and it would go “to some other
person in line. “An effort to save you is done, and we have people waiting, “so
we’re not gonna continue treating you “with the ventilator.”
– Wow. And then,
who makes that call?
– So, that would be the triage committee will evaluate
people at 48-hour intervals.
– Gorovitz says hospitals could, as a last resort,
use a randomization process, such as a lottery to decide distribution. There are
some circumstances, I know you all thought of this, when discretion doesn’t
really play that much of a role; the best you can do is a lottery.
– Yes, and,
in fact, the guidelines do allow for lottery. You have to be clear and explicit
and operationally rigorous about how the lottery is to be done. The outcome will
be horrible for whoever doesn’t win the lottery.
– New York’s Department of
Health declined to comment on any particular policies it may be considering. All
of this is just so wildly unpleasant to even contemplate and discuss.
– It is
exactly that. It is searingly difficult even to have to think about it.
