The allocation of scarce medical resources: Ethical and citizen issues
Audibert, Gérard
The allocation of scarce medical resources: Ethical and citizen issues - 2022.
86
While the ethics support units set up by the Ethical Reflection Centers in France have responded to all kinds of referrals, it is the issue of triage or prioritization in intensive care that has been the most publicized and controversial. Why? Admission decisions in intensive care are always complex and made according to multiple criteria and constraints, in a limited time and in the absence of elements of certainty. Resources from peers, such as severity scores, exist and help in decision-making, but in the context of a health crisis such as the one we experienced in spring 2020, the issue is no longer strictly medical: it is also a societal issue that engages the whole community, through the prism of distributive justice. Faced with this challenge, three options are possible: the utilitarian option, favored by Anglo-American authors but mostly rejected in France; the egalitarian option, which is difficult to apply when dealing with emergencies; and the priority option, which is certainly easy to apply but is morally very questionable. Algorithms can then appear as a magic solution to optimize decision-making. Regardless of the preferred option, transparency on the criteria adopted for admission to intensive care is necessary, which assumes the participation of citizens in the development of recommendations for prioritization. The doctor is always the one who, after a process of collegial deliberation, makes the decision of whether to continue or stop treatment. But the weight of this decision will be less heavy to carry if the data part of its consideration will have been the subject of democratic debates revolving around these topics.
The allocation of scarce medical resources: Ethical and citizen issues - 2022.
86
While the ethics support units set up by the Ethical Reflection Centers in France have responded to all kinds of referrals, it is the issue of triage or prioritization in intensive care that has been the most publicized and controversial. Why? Admission decisions in intensive care are always complex and made according to multiple criteria and constraints, in a limited time and in the absence of elements of certainty. Resources from peers, such as severity scores, exist and help in decision-making, but in the context of a health crisis such as the one we experienced in spring 2020, the issue is no longer strictly medical: it is also a societal issue that engages the whole community, through the prism of distributive justice. Faced with this challenge, three options are possible: the utilitarian option, favored by Anglo-American authors but mostly rejected in France; the egalitarian option, which is difficult to apply when dealing with emergencies; and the priority option, which is certainly easy to apply but is morally very questionable. Algorithms can then appear as a magic solution to optimize decision-making. Regardless of the preferred option, transparency on the criteria adopted for admission to intensive care is necessary, which assumes the participation of citizens in the development of recommendations for prioritization. The doctor is always the one who, after a process of collegial deliberation, makes the decision of whether to continue or stop treatment. But the weight of this decision will be less heavy to carry if the data part of its consideration will have been the subject of democratic debates revolving around these topics.
Réseaux sociaux