Alexander F C Hulsbergen1,2, Marleen M Eijkholt3,4, Naci Balak3, Jannick Brennum3, Ciarán Bolger3,5, Anna-Margarete Bohrer3, Zeev Feldman3, Daniel Holsgrove3, Neil Kitchen3, Tiit I Mathiesen3,6,7,8, Wouter A Moojen3,9, Nicolás Samprón3,10, Martin Sames3, Ulrika Sandvik3,8, Magnus Tisell3, Marike L D Broekman11,12. 1. Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium. a.f.c.hulsbergen@students.uu.nl. 2. Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Lijnbaan 32, 2512, VA, The Hague, The Netherlands. a.f.c.hulsbergen@students.uu.nl. 3. Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium. 4. Unit Ethics and Health Care, Leiden University Medical Center, Leiden, The Netherlands. 5. Department of Clinical Neuroscience, Beaumont Hospital, Dublin, Ireland. 6. Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. 7. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 8. Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Intitutet, Stockholm, Sweden. 9. Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Lijnbaan 32, 2512, VA, The Hague, The Netherlands. 10. Department of Neurosurgery, Hospital Universitario Donostia, San Sebastián, Spain. 11. Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium. m.broekman@haaglandenmc.nl. 12. Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Lijnbaan 32, 2512, VA, The Hague, The Netherlands. m.broekman@haaglandenmc.nl.
Abstract
BACKGROUND: The COVID-19 pandemic confronts healthcare workers, including neurosurgeons, with difficult choices regarding which patients to treat. METHODS: In order to assist ethical triage, this article gives an overview of the main considerations and ethical principles relevant when allocating resources in times of scarcity. RESULTS: We discuss a framework employing four principles: prioritizing the worst off, maximizing benefits, treating patients equally, and promoting instrumental value. We furthermore discuss the role of age and comorbidity in triage and highlight some principles that may seem intuitive but should not form a basis for triage. CONCLUSIONS: This overview is presented on behalf of the European Association of Neurosurgical Societies and can be used as a toolkit for neurosurgeons faced with ethical dilemmas when triaging patients in times of scarcity.
BACKGROUND: The COVID-19 pandemic confronts healthcare workers, including neurosurgeons, with difficult choices regarding which patients to treat. METHODS: In order to assist ethical triage, this article gives an overview of the main considerations and ethical principles relevant when allocating resources in times of scarcity. RESULTS: We discuss a framework employing four principles: prioritizing the worst off, maximizing benefits, treating patients equally, and promoting instrumental value. We furthermore discuss the role of age and comorbidity in triage and highlight some principles that may seem intuitive but should not form a basis for triage. CONCLUSIONS: This overview is presented on behalf of the European Association of Neurosurgical Societies and can be used as a toolkit for neurosurgeons faced with ethical dilemmas when triaging patients in times of scarcity.
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