Mark D. Siegel, MD
Potential Financial Conflicts of Interest: None disclosed.
Siegel M.; Ethical Issues and the Allocation of Scarce Resources During a Public Health Emergency. Ann Intern Med. 2009;150:889-890. doi: 10.7326/0003-4819-150-12-200906160-00018
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Published: Ann Intern Med. 2009;150(12):889-890.
TO THE EDITOR:
White and colleagues (1) have proposed a carefully considered algorithm to ensure appropriate use of resources during a public health disaster. Their system should be widely applicable and reflects commonly held values.
White and colleagues acknowledge the difficulty in denying access to specific patient groups. Therefore, their system does not address conditions associated with diminished functional (particularly cognitive) status. However, a just system cannot avoid taking these conditions into account.
Permanent unconsciousness is an example. Consider 2 women age 42 years with septic shock and respiratory failure, neither with significant comorbid conditions that would limit long-term survival. One is a wife and mother of 3; the other is permanently unconscious following traumatic brain injury. As I understand it, the authors' “multiprinciple strategy” would not distinguish between these individuals.
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