• Miho TANAKA

Part 2: パンデミック時における人工呼吸器治療の差し控え・中止議論に関する資料を公開します

最終更新: 11月18日

COVID-19パンデミック時における人工呼吸器治療の差し控え・中止議論について、2020年9月13日、第32回生命・医療倫理研究会で発表しました(Part 1: ACPからの続き)。これまでの報道や論文などから、諸外国ではどのような議論があったのか、どのような倫理的課題が提示されたのか、現時点での情報をまとめた資料を公開いたします。資料作成に使用した引用文献は次の通りです。

Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, Zhang C, Boyle C, Smith M, Phillips JP. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med. 2020 Mar 23. doi: 10.1056/NEJMsb2005114. [Epub ahead of print]

Cohen IG, Crespo AM, White DB. Potential Legal Liability for Withdrawing or Withholding Ventilators During COVID-19: Assessing the Risks and Identifying Needed Reforms. JAMA. 2020;323(19):1901–1902. doi:10.1001/jama.2020.5442

毎日新聞「『私は若い⼈に⾼度医療を譲ります』注⽬浴びる新型コロナ『意思カード』」2020年6月6日. https://mainichi.jp/articles/20200606/k00/00m/040/135000c

SIAARTI. CLINICAL ETHICS RECOMMENDATIONS FOR THE ALLOCATION OF INTENSIVE CARE TREATMENTS, IN EXCEPTIONAL, RESOURCE-LIMITED CIRCUMSTANCES. 16th March 2020. http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI/SIAARTI%20-%20Covid-19%20-%20Clinical%20Ethics%20Reccomendations.pdf

川口浩一, 吉中信人. イタリアにおける集中治療トリアージについて. 法律時報. 2020; 92(7): 56-61.

The Telegraph. Italians over 80 'will be left to die' as country overwhelmed by coronavirus. 14 March 2020.

Europe Reloaded. Coronavirus: Elderly Europeans Targeted, Denied Treatment. 16 April 2020. https://www.europereloaded.com/coronavirus-elderly-europeans-targeted-denied-treatment/

Rosenbaum L. Facing Covid-19 in Italy – Ethics, Logistics, and Therapeutics on the Epidemic’s Front Line. N Engl J Med. 2020 Mar 18. doi: 10.1056/NEJMp2005492. [Epub ahead of print]

Libertad Digital. Medicina de guerra en Cataluña: la Generalidad aconseja morir en casa. 1 APR 2020. https://www.libertaddigital.com/espana/2020-04-01/coronavirus-medicina-de-guerra-en-cataluna-la-generalidad-aconseja-morir-en-casa-1276655114/

JACOBIN. How Spain Shamed Itself by Leaving the Elderly to Die Under Coronavirus. 6 JUNE 2020. https://jacobinmag.com/2020/06/spain-covid-deaths-nursing-homes-madrid

The WIRE. Coronavirus: How Spain Left Its Elderly to Die. 28 JUNE 2020. https://thewire.in/world/coronavirus-how-spain-left-its-elderly-to-die

New York State Task Force on Life and the Law, New York State Department of Health. VENTILATOR ALLOCATION GUIDELINES. November 2015. https://www.health.ny.gov/regulations/task_force/reports_publications/docs/ventilator_guidelines.pdf

Politico. Northwell memo calls for rationing ventilators to 'patients most likely to benefit’. 3 APR 2020. https://www.politico.com/states/new-york/albany/story/2020/04/03/northwell-memo-calls-for-rationing-ventilators-to-patients-most-likely-to-benefit-1271711

BMA. COVID-19: ethical issues. https://www.bma.org.uk/advice-and-support/covid-19/ethics/covid-19-ethical-issues

日本医師会総合政策研究機構. COVID-19 の倫理的諸問題 ガイダンス⽂書の⽇本語版(仮訳). May 2020. https://www.jmari.med.or.jp/download/finalfile_bma_ethical_guidance.pdf

Rhodes A, Ferdinande P, Flaatten H, Guidet B, Metnitz PG, Moreno RP. The variability of critical care bed numbers in Europe. Intensive Care Med. 2012;38(10):1647-1653. doi:10.1007/s00134-012-2627-8

Verweij M, van de Vathorst S, Schermer M, Willems D, de Vries M, Ethical Advice for an Intensive Care Triage Protocol in the COVID-19 Pandemic: Lessons Learned from The Netherlands. Public Health Ethics. 3 September 2020. phaa027. https://doi.org/10.1093/phe/phaa027

Reuters. Dutch end-of-life debate flares as coronavirus tests healthcare limits. 3 APRIL 2020. https://www.reuters.com/article/us-health-coronavirus-netherlands-elderl-idUSKBN21K2B6

James E. Hurford LLB (Hons), LLM, MA, Solicitor (2020): The BMA COVID-19 ethical guidance: a legal analysis, The New Bioethics, DOI: 10.1080/20502877.2020.1762027

一家綱邦, 船橋亜希子. COVID-19 パンデミック下の人工呼吸器トリアージ問題にどう取り組むべきか. 病院. 2020; 79(8): 610-616.

Liddell K, Skopek JM, Palmer S, et al. Who gets the ventilator? Important legal rights in a pandemic. J Med Ethics. Epub ahead of print. doi:10.1136/medethics-2020-106332




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