pile ou face ou courte paille?
signalé par le crofsblog
potential patients can't be separated on a "first come, first served" basis
WELLINGTON, New Zealand
An emergency room doctor flipping a coin ultimately may decide who gets drugs, a ventilator or hospital bed if a flu pandemic overwhelms available medical resources in New Zealand.
A set of criteria to prioritize scarce resources at a time of overwhelming demand was proposed Friday by Michael Ardagh, professor of emergency medicine at Christchurch School of Medicine, in an article in the "New Zealand Medical Journal."
His option of tossing a coin or drawing straws comes in at the point that demand is overwhelming.
Ardagh said that when potential patients can't be separated on a "first come, first served" basis, access to resources may have to be determined by "a process of equal and unbiased chance, such as tossing a coin or use of a ballot."
He says he is attempting to offer pragmatic guidance to assist health workers decide how to deny some patients access to resources when demand can't be met.
New Zealand authorities acknowledge that the health system will not be able to cope at the height of a severe influenza pandemic that could affect 40 percent of the country's 4 million people and kill 33,000.
While no one can predict when a pandemic may strike, the H5N1 strain of bird flu has killed at least 148 people worldwide since it emerged in Asia three years ago.
Experts fear the virus could mutate into a form that is easily transmitted from person to person, possibly setting off a flu pandemic.
Ardagh said medics should consider seven criteria for accessing resources before any coin is flipped or straw drawn.
Criteria one and two determine whether the drug, ventilator or other resource is appropriate for the patient and whether there is competition for it.
Three asks doctors to consider alternative treatments and four whether any patients can have treatment deferred without significant harm: if it can, "then it should be."
Five looks at expanding resources by shifting staff to augment acute care, while six considers whether other options could mitigate likely harm for those who may miss out. "Harm" is not defined.
Seven ranks those left by comparing their ability to benefit or help others. Being a health worker or having dependents likely could mean a higher ranking.
If patients can't be ranked, "then proceed to ... a process of equal and unbiased chance" — "tossing a coin or use of a ballot," he writes.
Ardagh notes that applying the criteria "will be made more palatable by transparency about (them) and how they are being applied."
He also urges public discussion of the criteria, saying that communicating them before they're needed will ease their application during a pandemic.
http://www.iht.com/articles/ap/2006/10/13/asia/AS_MED_New_Zealand_Pandemic_Demand.php
si vous êtes abonnés ... http://www.nzma.org.nz/journal/abstract.php?id=2256