Ventilator Allocation and Mental Health Interventions 呼吸机配置与心理健康干预.pptVIP

QUESTIONS? Pat Anders(518) 474-2893pea02@health.state.ny.us Ventilator Allocation and Mental Health Interventions in a Pandemic Flu Event Patricia Anders Director, Emergency Preparedness Training New York State Department of Health Office of Health Emergency Preparedness Confronting the Ethics of Pandemic Influenza Planning The 2008 Summit of the States Ventilator Shortage in a Pandemic Different estimates of severity based on CDC calculations Federal ventilator stockpile NYS ventilator stockpile Most severe epidemic: Too few ventilators for patients Too few staff for more ventilators Rationing of ventilators needed Ventilator Allocation Guidance Document Written by the New York State Task Force on Life and Law Co-chaired by Tia Powell, M.D., and Gus Birkhead, M.D. Released in draft in March, 2007 for comment Available on NYSDOH website: /diseases/communicable/influenza/pandemic/ventilators/ Planning focus groups for community education, comment, and revision Rationing – Ethical Implications Limits patient autonomy Limits physician autonomy Shifts doctor’s obligation from patient to group Radical threat to doctor- patient relationship Ethical Framework Duty to Care ** Duty to Steward Resources ** Duty to Plan Transparency Justice ** Key ethical concepts Duty to Care Physician must care for individual patient Autonomy not decisive factor Palliative Care Duty to Steward Resources Disaster = Scarcity Survival for greatest number Allocation of resources First come, first served Most vulnerable Best balance of resource use and survival Duty to Plan Obligation to healthcare professionals and community Lack of planning creates vulnerability for front-line providers Flawed plan versus no plan Predictable emergency Justice Objective clinical criteria Applied broadly and evenly No differential access for special groups Transparency Public Communication Disaster care different Patient preference does not determine withdrawal or withholding of car