OBJECTIVE: The objective of this study was to examine whether patient selection or triage requires placing a relative value on human lives and whether the values placed on these lives are consistent with current ethical theories. STUDY DESIGN: An anonymous questionnaire was administered to groups of physicians and students in Montreal. It presented eight currently incompetent patients with potential neurological sequelae requiring emergency care. Predicted outcomes were explicitly described. Four patients had a predicted 50% survival and a 50% chance of impairment; they were a preterm and a term neonate, a 2-month-old and a 50-year-old. Two already disabled patients, a 7-year-old and an 80-year-old, had 50% predicted survival. A 14-year-old and a 35-year-old had 5% survival, but differing impairment. Respondents were asked if they would resuscitate and in what order they would resuscitate if all needed intervention simultaneously. RESULT: Eighty-five percent response rate, n=524. The proportion stating they would always resuscitate was smallest for the 80-year-old (18% P<0.001 compared to other patients), then the preterm (35%, P<0.001), then the term and the 50-year-old (53 and 58%, P<0.01). The 2-month-old and the 7-year-old would be resuscitated most frequently (74 and 77%, P<0.01), followed by the patients with 5% survival (64 and 68%, P<0.001). The median order of triage was first the 2-month-old, followed by the 7-year-old, the 14-year-old, the term newborn, the 50-year-old, the 35-year-old, the premature newborn and the 80-year-old. CONCLUSION: Order of resuscitation was not closely related to the predicted survival, impairment or potential life years gained. Age appeared to have a strong influence, with children's lives being valued more than the adults'. This tendency was reversed for the newborn infants who were undervalued compared with older children, and most particularly for the premature. The value placed on the life of newborns, in particular the premature, is less than that expected by any objective medical data and was not consistent with any ethical theory that we tested.
OBJECTIVE: The objective of this study was to examine whether patient selection or triage requires placing a relative value on human lives and whether the values placed on these lives are consistent with current ethical theories. STUDY DESIGN: An anonymous questionnaire was administered to groups of physicians and students in Montreal. It presented eight currently incompetent patients with potential neurological sequelae requiring emergency care. Predicted outcomes were explicitly described. Four patients had a predicted 50% survival and a 50% chance of impairment; they were a preterm and a term neonate, a 2-month-old and a 50-year-old. Two already disabled patients, a 7-year-old and an 80-year-old, had 50% predicted survival. A 14-year-old and a 35-year-old had 5% survival, but differing impairment. Respondents were asked if they would resuscitate and in what order they would resuscitate if all needed intervention simultaneously. RESULT: Eighty-five percent response rate, n=524. The proportion stating they would always resuscitate was smallest for the 80-year-old (18% P<0.001 compared to other patients), then the preterm (35%, P<0.001), then the term and the 50-year-old (53 and 58%, P<0.01). The 2-month-old and the 7-year-old would be resuscitated most frequently (74 and 77%, P<0.01), followed by the patients with 5% survival (64 and 68%, P<0.001). The median order of triage was first the 2-month-old, followed by the 7-year-old, the 14-year-old, the term newborn, the 50-year-old, the 35-year-old, the premature newborn and the 80-year-old. CONCLUSION: Order of resuscitation was not closely related to the predicted survival, impairment or potential life years gained. Age appeared to have a strong influence, with children's lives being valued more than the adults'. This tendency was reversed for the newborn infants who were undervalued compared with older children, and most particularly for the premature. The value placed on the life of newborns, in particular the premature, is less than that expected by any objective medical data and was not consistent with any ethical theory that we tested.
Authors: N Laventhal; A A E Verhagen; T W R Hansen; E Dempsey; P G Davis; G A Musante; A Wiles; W Meadow; A Janvier Journal: J Perinatol Date: 2016-10-13 Impact factor: 2.521
Authors: Annie Janvier; Keith J Barrington; Khalid Aziz; Eduardo Bancalari; Daniel Batton; Carlo Bellieni; Brahim Bensouda; Carlos Blanco; Po-Yin Cheung; Felicia Cohn; Thierry Daboval; Peter Davis; Eugene Dempsey; Amélie Dupont-Thibodeau; Emanuela Ferretti; Barbara Farlow; Matteo Fontana; Etienne Fortin-Pellerin; Aviva Goldberg; Thor Willy Ruud Hansen; Marlyse Haward; Lajos Kovacs; Anie Lapointe; John Lantos; Colin Morley; Ahmed Moussa; Gabriel Musante; Sophie Nadeau; Colm Pf O'Donnell; Kristina Orfali; Antoine Payot; C Anthony Ryan; Guilherme Sant'anna; Ola D Saugstad; Sadath Sayeed; Theophil A Stokes; Eduard Verhagen Journal: Paediatr Child Health Date: 2014-01 Impact factor: 2.253
Authors: Cecelia I Roscigno; Teresa A Savage; Karen Kavanaugh; Teresa T Moro; Sarah J Kilpatrick; Howard T Strassner; William A Grobman; Robert E Kimura Journal: Qual Health Res Date: 2012-06-28