How would overwhelmed hospitals decide who to treat first?
CANDICE CHOI, LORI HINNANT and NICOLE WINFIELD 坎迪斯·崔，蘿莉·赫南特和妮可·溫菲爾德
Associated Press 美聯社March 30, 2020, 9:13 PM GMT+82020年3月30日，格林尼治標準時間晚上9:13 +8
NEW YORK (AP) — A nurse with asthma, a grandfather with cancer and a homeless man with no known family are wracked with coronavirus-induced fevers. They are struggling to breathe, and a ventilator could save their lives. But who gets one when there aren't enough to go around?
紐約(美聯社)——一名患有哮喘的護士，一名患有癌症的祖父，以及一名無家可歸、沒有家人的男子，都因為冠狀病毒引起的發燒而飽受折磨。他們呼吸困難，而呼吸機可以挽救他們的生命。但是，當沒有足夠的食物分發時，誰會得到一個?
Health care workers are dreading the prospect of such dire scenarios as U.S. hospitals brace for a looming surge in patients who need breathing machines and other resources that could soon be in critically short supply.
醫療工作者擔心出現這種可怕的情況，因為美國的醫院正在為即將到來的病人激增做準備，這些病人需要呼吸機和其他資源，而這些資源可能很快就會嚴重短缺。
That has meant dusting off playbooks they’ve never before had to implement on how to fairly ration limited resources during an emergency.
這意味著，他們必須重新拿出以前從未使用過的劇本，在緊急情況下如何公平分配有限的資源。
“I pray for their good judgment and their capacity as they make very difficult choices,” said Erik Curren, whose 77-year-old father died this month from respiratory complications related to the virus after becoming infected at an assisted living home in Florida.
“我為他們的判斷力和能力祈禱，因為他們做出了非常艱難的選擇，”埃裡克·克倫(Erik Curren)說。
Harrowing scenarios already are unfolding in country after country hard-hit by the COVID-19 pandemic, including Spain, where one nursing home official said sick residents are dying after being unable to get into overflowing hospitals.
在一個又一個遭受19號致命傳染病重創的國家，包括西班牙，已經出現了令人痛心的情況。西班牙一家療養院的官員說，病人因無法進入人滿為患的醫院而死亡。
Like much of the rest of the world, ventilators that help people breathe are in particular demand across the U.S., given the respiratory problems common among people severely ill with COVID-19.
與世界上其他許多地方一樣，美國各地對幫助人們呼吸的呼吸機有著特別的需求鑑於COVID-19在重症患者中常見的呼吸系統問題。
As many as 900,000 coronavirus patients in the U.S. could need the machines during the outbreak, according to the Society for Critical Care Medicine. Yet the group estimates the country has only 200,000, many of which already are being used by other patients.
美國重症監護醫學協會(Society for Critical Care Medicine)的數據顯示，在疫情爆發期間，美國可能有多達90萬冠狀病毒患者需要這種機器。然而，該組織估計該國只有20萬，其中許多已經被其他病人使用。
In New York, the U.S. epicenter of the outbreak, one city hospital has already logged 13 coronavirus deaths in a single day and officials are setting up hundreds of hospital beds in a sprawling convention center as cases climbed past 30,000 in the city.
在美國爆發疫情的中心紐約，一家市立醫院一天之內就有13人死於冠狀病毒，官員們正在一個龐大的會議中心搭建數百張病床，該市的病例已超過3萬例。
In preparation, health officials across the country are reviewing guidelines from sources including state governments and medical groups on how to ration limited resources in emergencies.
在準備過程中，全國各地的衛生官員正在審查來自各州政府和醫療團體的指導方針，以確定在緊急情況下如何分配有限的資源。
The general principle spanning those plans: Bring the most benefit to the greatest number of people and prioritize those with the best chance of recovery. But exactly how that’s determined is fraught.
這些計劃的基本原則是:為最多人帶來最大的利益，優先考慮那些最有可能康復的人。但具體如何確定是令人擔憂的。
Automatically excluding certain groups from receiving ventilators, such as those with severe lung disease, invokes ethical issues, said Dr. Douglas White at the University of Pittsburgh. Many hospitals seeking guidance on COVID-19 in recent weeks have adopted a policy he devised without such exclusions, he said.
匹茲堡大學(University of Pittsburgh)的道格拉斯·懷特(Douglas White)博士說，自動將某些群體排除在呼吸機之外，比如那些患有嚴重肺病的群體，這涉及到倫理問題。他說，最近幾周，許多尋求COVID-19指南的醫院都採納了他設計的一項政策，沒有把這些排除在外。
Guidelines previously developed by New York state’s health department exclude some seriously ill people from receiving limited ventilators in major emergencies, but note that making old age an automatic disqualifier would be discriminatory. The plans go on to add, however, that given the “strong societal preference for saving children,” age could be considered in a tie-breaker when a child’s life is at stake.
之前由紐約州衛生部門制定的指導方針排除了一些重症患者在重大緊急情況下使用有限的呼吸器，但是注意到將老年作為自動取消資格的規定是有歧視性的。然而，該計劃還補充說，考慮到“社會對救助兒童的強烈偏好”，當兒童的生命受到威脅時，年齡可能被視為決定因素之一。
Recommendations published this week by German medical associations in response to COVID-19 also say age alone shouldn’t be a deciding factor. Among the situations where they said intensive care should not be provided if availability is in short supply: if the patient would need permanent intensive care to survive.
德國醫學協會(German medical associations)本週針對COVID-19發表的建議也說，年齡不應該是唯一的決定因素。在這些情況下，他們說如果可用性短缺，就不應該提供重症監護:如果病人需要永久性的重症監護才能生存。
The crushing emotional burden of carrying out potentially life-and-death decisions is why the guidelines typically designate separate triage teams to make the call, rather than leaving it to the doctors and nurses providing bedside care.
執行可能的生死抉擇所帶來的沉重情感負擔，是該指南通常指定單獨的分診小組來做決定的原因，而不是讓醫生和護士來提供床邊護理。
“This is a really terrifying decision -- you don’t want any doctor or nurse to be alone with this decision,” said Nancy Berlinger of the Hastings Center, a bioethics research institute.
“這是一個非常可怕的決定——你不想讓任何醫生或護士獨自面對這個決定，”生物倫理研究機構黑斯廷斯中心(Hastings Center)的南希·貝林格(Nancy Berlinger)說。
Having separate teams make decisions also is intended to ensure patients get a fair shot at care regardless of their race, social status or other personal factors.
讓不同的團隊做出決定，也是為了確保病人得到公平的治療機會，而不管他們的種族、社會地位或其他個人因素。
Berlinger noted that underlying social inequities can still persist -- for example, poorer people tend to be sicker -- but that those are deeper injustices that can’t be remedied in the throes of a pandemic.
貝林格指出，潛在的社會不平等可能仍然存在——例如，窮人往往病情更重——但這些是更深層次的不公平，在大流行的陣痛中是無法補救的。
Another grim calculation that experts say hospitals could make is how long a patient might need a hospital bed or ventilator and how many more lives the machine might otherwise save. That would help forestall an even more wrenching decision many doctors in the U.S. likely have never faced -- whether to take a patient off a machine to free it up for others.
專家們說，醫院可能會做的另一個嚴峻的計算是，病人需要病床或呼吸機的時間有多長，如果不使用呼吸機，還能挽救多少人的生命。這將有助於避免許多美國醫生可能從未面臨過的一個更痛苦的決定:是否要把病人從機器上取下來，讓其他人自由使用。
The norms don’t apply in the current crisis and taking precious resources away from one patient to save others in a pandemic “is not an act of killing and does not require the patient’s consent,” said a paper addressing the COVID-19 emergency published last week in the New England Journal of Medicine.
規範不適用在當前危機中,寶貴的資源從一個病人拯救其他大流行”不是一種行為殺死,並且不需要病人的同意,“說一篇論文解決COVID-19緊急上週發表在《新英格蘭醫學雜誌》上。
The authors noted that patients and their families should not be shielded from the realities and should be warned in advance of the possibility their loved one could be taken off a machine.
作者指出，病人和他們的家人不應該逃避現實，應該提前得到警告，因為他們的親人可能會被從機器上帶走。
Hospitals should also prepare alternatives for those who don’t make it to the top of the list for limited resources, such as stocking up on morphine, said Philip Rosoff of Duke University’s Trent Center for bioethics.
杜克大學(Duke University)特倫特生物倫理中心(Trent Center for bioethics)的羅索夫(Philip Rosoff)說，醫院還應該為那些因有限的資源(比如囤積嗎啡)而未能進入名單前列的病人準備替代方案。
It’s not yet known how dire the crisis in the U.S. will get. Last week, Dr. Deborah Birx, the White House coordinator for the coronavirus response, sought to calm fears, noting there’s no evidence yet that a hospital bed or ventilator won’t be available for Americans when they need it. Even in New York, she said, beds are still available in intensive care units and a significant number of ventilators aren’t being used.
目前還不清楚美國的危機會有多嚴重。上週，負責應對冠狀病毒的白宮協調員黛博拉·比爾克斯(Deborah Birx)博士試圖平息人們的擔憂，她指出，目前還沒有證據表明，在美國人需要的時候，醫院的病床或呼吸機將無法使用。她說，即使是在紐約，重症監護病房的床位仍然可用，大量的通風機沒有使用。
But what’s happening overseas has health care workers around the world preparing for worst-case scenarios.
但是海外發生的事情讓世界各地的醫療工作者為最壞的情況做準備。
In France and Spain, hospital and nursing officials say nursing home residents who come down with symptoms of coronavirus are not necessarily admitted to intensive care.
在法國和西班牙，醫院和護理官員說，有冠狀病毒症狀的療養院居民不一定要接受重症監護。
In hard-hit regions, "they are hospitalized only when there is a chance to save them," said Marc Bourquin of the French Hospital Federation.
法國醫院聯合會(French Hospital Federation)的馬克•布爾坎(Marc Bourquin)表示，在重災區，“只有在有機會挽救他們的時候，他們才會住院。”
Jesús Cubero, general secretary of AESTE, an association of nursing homes, said some residents end up dying after being unable to get into full hospitals.
養老院協會AESTE的秘書長赫蘇斯·庫貝羅(Jesus Cubero)表示，一些居民在無法入住完整的醫院後死亡。
In northern Italy, Dr. Luca Lorini at the Pope John XXIII hospital in hard-hit Bergamo, compared how patients are being triaged to people waiting for an organ transplant.
在意大利北部重災區貝加莫的教皇約翰二十三世醫院，盧卡·洛里尼醫生將病人與等待器官移植的病人進行了對比。
”One heart and 10 people who are waiting for a heart transplant. Who gets the heart? The one who has the greatest chance of living better and longer with that heart,” he said.
“一顆心臟和10個等待心臟移植的人。誰得到了心臟?擁有這顆心的人最有可能活得更好，活得更久，”他說。
In the U.S., the rapidly multiplying cases is creating fear that hospitals could soon be overwhelmed.
在美國在美國，越來越多的病例讓人擔心醫院可能很快就會人滿為患。
“The fact that we’re in a situation that one day we may not have enough ventilators is terrible and unacceptable,” said Zachary Shemtob, whose husband has been sedated and on one of the machines at NYU Langone hospital since testing positive for the virus.
“我們可能有一天會沒有足夠的呼吸機，這一事實是可怕的，也是不可接受的，”扎卡里·舍姆託布(Zachary Shemtob)說。
Curren, the Virginia man whose father died of COVID-19 last week, said he wouldn’t fault health-care workers for any of the agonizing decisions they may have to make in coming weeks -- and trusts that they have the training to do so.
柯倫的父親上週死於covid19，他說他不會因為醫療工作者未來幾周可能要做出的任何痛苦的決定而責怪他們，他相信他們受過這樣的訓練。
“These people are doing a fantastic job under war-time conditions,” he said.
他說:“這些人在戰時條件下幹得非常出色。
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Hinnant reported from Paris and Winfield reported from Rome. Trisha Thomas in Rome, Aritz Parra in Madrid, Jim Mustian in New York and Adriana Gomez Licon in Miami contributed.
希南特從巴黎報告，溫菲爾德從羅馬報告。羅馬的特麗莎·托馬斯(Trisha Thomas)、馬德里的阿里茨·帕拉(Aritz Parra)、紐約的吉姆·馬斯蒂安(Jim Mustian)和邁阿密的阿德里亞娜·戈麥斯·利肯(Adriana Gomez Licon)也有貢獻。
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
美聯社健康與科學部得到了霍華德·休斯醫學研究所科學教育系的支持。美聯社對所有內容全權負責。
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