Ethical triage during the COVID-19 pandemic: a toolkit for neurosurgical resource allocation.

Covid-19 Ethics Neurosurgery SARS-CoV-2 Triage

Journal

Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000

Informations de publication

Date de publication:
Jul 2020
Historique:
received: 07 04 2020
accepted: 25 04 2020
pubmed: 15 5 2020
medline: 15 5 2020
entrez: 15 5 2020
Statut: ppublish

Résumé

The COVID-19 pandemic confronts healthcare workers, including neurosurgeons, with difficult choices regarding which patients to treat. In order to assist ethical triage, this article gives an overview of the main considerations and ethical principles relevant when allocating resources in times of scarcity. We discuss a framework employing four principles: prioritizing the worst off, maximizing benefits, treating patients equally, and promoting instrumental value. We furthermore discuss the role of age and comorbidity in triage and highlight some principles that may seem intuitive but should not form a basis for triage. This overview is presented on behalf of the European Association of Neurosurgical Societies and can be used as a toolkit for neurosurgeons faced with ethical dilemmas when triaging patients in times of scarcity.

Sections du résumé

BACKGROUND BACKGROUND
The COVID-19 pandemic confronts healthcare workers, including neurosurgeons, with difficult choices regarding which patients to treat.
METHODS METHODS
In order to assist ethical triage, this article gives an overview of the main considerations and ethical principles relevant when allocating resources in times of scarcity.
RESULTS RESULTS
We discuss a framework employing four principles: prioritizing the worst off, maximizing benefits, treating patients equally, and promoting instrumental value. We furthermore discuss the role of age and comorbidity in triage and highlight some principles that may seem intuitive but should not form a basis for triage.
CONCLUSIONS CONCLUSIONS
This overview is presented on behalf of the European Association of Neurosurgical Societies and can be used as a toolkit for neurosurgeons faced with ethical dilemmas when triaging patients in times of scarcity.

Identifiants

DOI: 10.1007/s00701-020-04375-w PMID: 32405671 PMC: PMC7220806
pubmed: 32405671
doi: 10.1007/s00701-020-04375-w
pii: 10.1007/s00701-020-04375-w
pmc: PMC7220806
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1485-1490

Références

Lancet. 2009 Jan 31;373(9661):423-31
pubmed: 19186274
N Engl J Med. 2020 May 21;382(21):2049-2055
pubmed: 32202722

Auteurs

Alexander F C Hulsbergen (AFC)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium. a.f.c.hulsbergen@students.uu.nl.
Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Lijnbaan 32, 2512, VA, The Hague, The Netherlands. a.f.c.hulsbergen@students.uu.nl.
ORCID: 0000-0002-1869-5352

Marleen M Eijkholt (MM)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.
Unit Ethics and Health Care, Leiden University Medical Center, Leiden, The Netherlands.

Naci Balak (N)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.

Jannick Brennum (J)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.

Ciarán Bolger (C)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.
Department of Clinical Neuroscience, Beaumont Hospital, Dublin, Ireland.

Anna-Margarete Bohrer (AM)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.

Zeev Feldman (Z)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.

Daniel Holsgrove (D)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.

Neil Kitchen (N)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.

Tiit I Mathiesen (TI)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.
Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Intitutet, Stockholm, Sweden.

Wouter A Moojen (WA)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.
Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Lijnbaan 32, 2512, VA, The Hague, The Netherlands.

Nicolás Samprón (N)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.
Department of Neurosurgery, Hospital Universitario Donostia, San Sebastián, Spain.

Martin Sames (M)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.

Ulrika Sandvik (U)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.
Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Intitutet, Stockholm, Sweden.

Magnus Tisell (M)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.

Marike L D Broekman (MLD)

Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium. m.broekman@haaglandenmc.nl.
Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Lijnbaan 32, 2512, VA, The Hague, The Netherlands. m.broekman@haaglandenmc.nl.

Classifications MeSH