Ethical and political criteria for triage in times of health crisis: considering the allocation of scarce resources from disability
DOI:
https://doi.org/10.5902/2179378643980Keywords:
Resource allocation, Triage, Persons with Disabilities, Equality, Covid-19Abstract
The of scarcity of medical resources. In these circumstances, persons with disabilities are more vulnerable than they would be under normal circumstances. In light of this reality, we propose to present some criteria for the allocation of resources used during the crisis, highlighting their harmful nature for people with disabilities, and to analyze how the principle of non-discrimination can, if taken as a reference, contribute to the ethical and political reflection on the rationing protocols.
Downloads
References
AMARO, S. Lacking beds, masks and doctors, Europe’s health services struggle to cope with the coronavirus. CNBC, [S.l.], 03 apr. 2020. Health and Science. Disponível em: https://www.cnbc.com/2020/04/03/coronavirus-italy-spain-uk-health-services-struggle-to-cope.html. Acesso em: 28 abr. 2020.
ASIS ROIG, Rafael de. La Igualdad en el discurso de los derechos. In: LÓPEZ GARCÍA, J. A.; ALBERTO DEL REAL, J ( Ed.). Los derechos: entre la ética, el poder y el derecho. Madrid: Dykinson, 2000, p. 149-168.
ASIS ROIG, Rafael de. Sobre la discriminación positiva: especial referencia al Derecho europeo. In: MARIÑO MENÉNDEZ F.; FERNÁNDEZ LIESA, C. La protección de las personas y grupos vulnerables en el Derecho europeo. Madrid: BOE. Boletín Oficial del Estado, 2001, p. 27-51.
ASÍS ROIG, Rafael de. Sobre el modelo social de discapacidad: críticas y éxito. Papeles el tiempo de los derechos. [S.l], n. 1, 2013. Disponível em: https://e-archivo.uc3m.es/handle/10016/19304. Acesso em: 25 abr. 2020.
ASÍS ROIG, Rafael. Lo razonable en el concepto de ajuste razonable. In: SALMÓN, E.; BREGAGLIO, R (Eds.). Nueve conceptos claves para entender la Convención sobre los derechos de las personas con discapacidad. Lima: IDEHPUCP, 2015, p. 99-118.
BAGENSTOS, Samuel R. May Hospitals Withhold Ventilators from COVID-19 Patients with Pre-Existing Disabilities? Notes on the Law and Ethics of Disability-Based Medical Rationing, Yale Law Journal Forum, v. 130 , 24 mar. 2020. Disponível em: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3559926. Acesso em: 25 abr. 2020. DOI: https://doi.org/10.2139/ssrn.3559926
BARNES, Elizabeth. Valuing Disability, Causing Disability, Ethics, Chicago, v. 125, n. 1, p. 88-113, oct. 2014. Disponível em: https://www.jstor.org/stable/10.1086/677021?seq=1#metadata_info_tab_contents. Acesso em: 30 abr. 2020. DOI: https://doi.org/10.1086/677021
BOBBIO, Norberto. Igualdade e Liberdade. Rio de Janeiro: Ediouro, 1997.
BRITISH MEDICAL ASSOCIATION (BMA). Covid-19 – ethical issues. A guidance note. United Kingdom: British Medical Association, 2020. Disponível em: https://www.bma.org.uk/media/2226/bma-covid-19-ethics-guidance.pdf . Acesso em: 25 abr. 2020.
CHISHOLM, John. Doctors will have to choose who gets life-saving treatment. Here’s how we’ll do it. The Guardian, London, 1 apr. 2020. Opinion. Disponível em: https://www.theguardian.com/commentisfree/2020/apr/01/doctors-choose-life-saving-treatment-ethical-rules. Acesso em: 25 abr. 2020.
CUENCA, Patricia. Sobre la inclusión de la discapacidad en la teoría de los derechos humanos. Revista de Estudios Políticos (nueva época). Madrid, n. 158, p. 103-137, octubre-diciembre 2012.
EMANUEL, E.J. et al. Fair allocation of scarce medical resources in the time of Covid-19. The New England Journal of Medicine, [S.l.], 23 apr. 2020. Disponível em: https://www.nejm.org/doi/pdf/10.1056/NEJMsb2005114?articleTools=true. Acesso em: 30 abr. 2020.
GALLÓN, N. Bodies are being left in the streets in an overwhelmed Ecuadorian city. CNN, [S.l.], 04 apr. 2020. Disponível em: https://edition.cnn.com/2020/04/03/americas/guayaquil-ecuador-overwhelmed-coronavirus-intl/index.html. Acesso em: 28 abr. 2020.
HELMANN, D.; NICHOLSON, K. Rationing and Disability in a State of Crisis. Public Law and Legal Theory Research Paper, [S.l.], n. 2020-33, p. 01-26, apr. 2020. Disponível em: https://ssrn.com/abstract=3570088. Acesso em: 29 abr. 2020[1].
KITTAY, Eva. Love’s Labor: essays on women, equality and dependency. New York: Routledge. 1999.
LAUDETE, C.; PINEDO, E. Espanha tem aumento de mortes; total supera 19 mil. Terra, 16 abr. 2020. Coronavírus. Disponível em: https://www.terra.com.br/noticias/coronavirus/espanha-tem-aumento-de-mortes-total-supera-19-mil,03a0925488465e166af6be0dfb758a3c8bi36jrc.html. Acesso em: 28 abr. 2020.
MICHALOWSKI, S. et al. Triage in the COVID-19 Pandemic Bioethical and Human Rights Considerations. A Joint Technical Report of the Essex Autonomy Project & the Ethics of Powerlessnes Project - School of Law; School of Philosophy and Art History, University of Essex, Essex, 2020.
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE). COVID-19 rapid guideline: critical care. [S.l.]: NICE, 2020. Disponível em: https://www.nice.org.uk/guidance/ng159/resources/covid19-rapidguideline-critical-care-in-adults-pdf-66141848681413. Acesso em: 25 abr. 2020.
NEW YORK STATE TASK FORCE ON LIFE AND THE LAW; NEW YORK STATE DEPARTMENT OF HEALTH. Ventilator Allocation Guidelines, [S.l.]: New York State Task Force on Life and The Law; New York State Department of Health, 2015. Disponível em: https://www.health.ny.gov/regulations/task_force/reports_publications/docs/ventilator_guidelines.pdf. Acesso em: 28 abr. 2020.
PATHAK, Parag. et al. Leaving No Ethical Value Behind:Triage Protocol Design for Pandemic Rationing, NBER Working Papers Series, Cambridge, n. 26951, p. 01-45, apr. 2020. Disponível em: https://economics.mit.edu/files/19358. Acesso em: 28 abr. 2020.
PARFIT, Derek. Innumerate Ethics. Philosophy & Public Affairs,[S.l.], v. 7, n. 4, p. 285-301, 1978. Disponível em: https://www.jstor.org/stable/2264959. Acesso em: 30 abr. 2020.
PERSAD, Govind. Why Disability Law Permits Evidence-Based Triage in a Pandemic. Yale Journal Forum, [S.l.], v. 130, U Denver Legal Studies Research Paper n. 20-10, 8 apr. 2020 . Disponível em: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571139. Acesso em: 30 abr. 2020.
RAWLS, John. Uma teoria de Justiça. Trad. Almiro Pisetta e Lenitta M. R. Esteves. São Paulo: Martins Fontes. 1997.
RAWLS, John. O liberalismo político. Trad. Dinah de Abreu Azevedo. 2. ed. 2. Imp. São Paulo : ed. Ática. 2000.
ROCKWOOD, K. et al. 2005. A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal. [S.l.], v. 173, Issue 5, p. 489-495, aug. 2005. Disponível em: https://www.cmaj.ca/content/cmaj/173/5/489.full-text.pdf. Acesso em: 30 abr. 2020. DOI: https://doi.org/10.1503/cmaj.050051
UW Medicine. Material Resources Allocation and Principles. Covid-19 outbreak. [S.l.]: UW Medicine, 05 apr. 2020. Disponível em: https://covid-19.uwmedicine.org/Screening%20and%20Testing%20Algorithms/Other%20Inpatient%20Clinical%20Guidance/Clinical%20Care%20in%20ICU/Material%20Resource%20Allocation.COVID19.docx. Acesso em: 28 abr. 2020.
VERGANO, M. et. al. Clinical ethics recommendations for the allocation of intensive treaments, in exceptional, resource-limited circumstances. [S.l.]: SIAARTI, 16 mar. 2020. Disponível em: http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI/SIAARTI%20-%20Covid-19%20-%20Clinical%20Ethics%20Reccomendations.pdf. Acesso em: 28 abr. 2020.
VITA, Álvaro de. A tarefa prática da filosofia política em John Rawls. Lua Nova: Revista de Cultura e Política, São Paulo , n. 25, p. 05-24, abr. 1992. DOI: https://doi.org/10.1590/S0102-64451992000100002
VITORIO, T.; ROVAROTO, I. 1 milhão de infectados e 56 mil mortos: um retrato do coronavírus nos EUA. Exame, [S.l.], 28 abr. 2020. Mundo. Disponível em: https://exame.abril.com.br/mundo/1-milhao-de-infectados-e-56-mil-mortos-um-retrato-do-coronavirus-nos-eua/. Acesso em: 28 abr. 2020.
WOLF, Leslie; WENDY, Hensel. Valuing lives: Allocating scarce medical resources during a public health emergency and the Americans with Disabilities Act (perspective). PLoS Currents, [S.l.], 21 sep. 2011. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199960/?report=reader. Acesso em: 30 abr. 2020. DOI: https://doi.org/10.1371/currents.RRN1271
Downloads
Published
How to Cite
Issue
Section
License
The submission of original manuscripts to this journal implies the transference, by the authors, of the copyrights for printed and digital publication. The copyrights of a published manuscript belong ultimately to the author, and only the copyright for its first publication is reserved to the journal. Authors may only use the same results in other publications explicitly indicating this journal as the medium of the original publication.
Licence
Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) - This license lets others remix, tweak, and build upon your work non-commercially, as long as they credit you and license their new creations under the identical terms.