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PMC:7204662 JSONTXT 18 Projects

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Id Subject Object Predicate Lexical cue
T1 0-36 Sentence denotes COVID-19 and ethical considerations:
T2 37-112 Sentence denotes Valuable decision-making tools from the leading medical societies in France
T3 114-297 Sentence denotes The current COVID-19 pandemic has resulted in a significant increase in the number of hospitalised patients requiring mechanical ventilation for severe acute respiratory distress [1].
T4 298-461 Sentence denotes In France, public health measures were implemented rapidly to limit the spread of SARS-CoV-2 and to permit hospitals to increase the number of intensive care beds.
T5 462-715 Sentence denotes However, these actions and the overall response to this crisis have raised serious ethical concerns, particularly with respect to triage and prioritisation of access to intensive care units (ICUs) if the demand ultimately exceeds the supply of care [2].
T6 716-1023 Sentence denotes Ethical reflection has been carried out at the national level by the National Consultative Ethics Committee ("Comité Consultatif National d’Ethique"), which provides advice toward guiding society and developing policies in the face of the ethical challenges such as those posed by the COVID-19 pandemic [3].
T7 1024-1207 Sentence denotes Additional operational recommendations have been put forward by the leading medical societies in France (FLMS) to assist practitioners with ongoing decision-making [4], [5], [6], [7].
T8 1208-1543 Sentence denotes These recommendations serve to remind everyone of the need to respect the critical and fundamental ethical principles that could be easily overlooked in a pandemic situation; these principles include respect for the dignity of all, non-maleficence, collegiality in all decisions and respect for the wishes and autonomy of each patient.
T9 1544-1742 Sentence denotes All agree that the principle of distributive justice takes on an important role in this context, just as it is taken into account in everyday life apart from the stresses introduced by the pandemic.
T10 1743-1928 Sentence denotes Decisions need to focus not only on the individual needs of a given patient, but also the good of society as a whole; this would include a focus on maximising the number of lives saved.
T11 1929-2133 Sentence denotes If one is taking into account the number of years of life to be saved, as suggested by the American recommendations, patient age will of necessity become a major criterion with respect to decision-making.
T12 2134-2266 Sentence denotes Indeed, the Italian Society for Intensive Care Medicine has put forward age thresholds for prioritising access to critical care [8].
T13 2267-2451 Sentence denotes The recommendations made and criteria chosen by the FLMS were introduced with all necessary transparency so as to facilitate their acceptance amongst physicians and the general public.
T14 2452-2580 Sentence denotes The criteria emphasise the need to protect the most vulnerable patients from the risk of discrimination and arbitrary decisions.
T15 2581-2899 Sentence denotes Criteria commonly used for decisions related to ICU admission include frailty, presence of co-morbidities, prior level of personal autonomy, nutritional status and cognition; patient age is included amongst these factors as well as the severity of the disease assessed by the Sequential Organ Failure Assessment score.
T16 2900-2967 Sentence denotes It is critical to recognise that no specific criteria were defined.
T17 2968-3330 Sentence denotes This was a deliberate decision; ICU admissions ultimately depend on the ability to adapt to circumstances within given situations and contexts; amongst the latter issues, much depends on the availability of critical care beds, resuscitation equipment and the requisite scientific and medical knowledge required for appropriate care and treatment of this disease.
T18 3331-3662 Sentence denotes Likewise, no age threshold been defined beyond which access to ICU care would be denied, save for statements included in the joint recommendation of the French Society of Anaesthesia and Intensive Care (Société française d’anesthésie et de réanimation) and the French Military Health Service (Service de santé des armées; SSA) [4].
T19 3663-3867 Sentence denotes However, consideration of patient age as a sole criterion does not seem to be acceptable; the consideration of any single criterion considered in isolation would not be appropriate in these circumstances.
T20 3868-4072 Sentence denotes It would appear that a discussion of all relevant criteria should be carried out without reference to any specific hierarchy; several helpful decision-making tools have been proposed by the SFAR [4], [5].
T21 4073-4325 Sentence denotes The authors propose several levels of prioritisation with respect to ICU treatment when faced with limited capacity for critically ill patients; these are colour-coded as indicated, with each priority level corresponding to a specific course of action.
T22 4326-4545 Sentence denotes As shown, there are four levels of priority; amongst the criteria to consider are the definitive need for resuscitation and the probability that an individual will derive significant benefit from this level of care [4].
T23 4546-5017 Sentence denotes This categorisation strategy is similar to that recommended for surgical triage in war and in response to a disaster; for example, the P4 category here is analogous to surgical “expectants” who are those individuals who are too badly injured, whose chances of survival are very limited, and whose appropriate management would require the implementation of too great or even too uncertain levels of resources to the detriment of others who are less seriously affected [9].
T24 5018-5211 Sentence denotes This text also proposes a cognitive aid in the form of decision-support algorithms that consider the proposed criteria and suggest a course of action based on the level of priority established.
T25 5212-5553 Sentence denotes Although these decision-making aids can be a valuable resource for practitioners who are required to make difficult decisions in emergency situations, their use does not preclude thorough individualised assessments using a thoughtful, rational and collegial approach that take into consideration patients’ wishes regarding invasive ICU care.
T26 5554-5689 Sentence denotes These criteria are by necessity evolving and will depend largely on the context and the availability of appropriate hospital resources.
T27 5690-5865 Sentence denotes Likewise, regular reassessment of these criteria should be undertaken on an individual basis during the hospital stay; no decisions should be considered as fixed or immutable.
T28 5866-6043 Sentence denotes In the event of a new epidemic peak of COVID-19 or a future health crisis, these recommendations, if used properly, will remain valuable tools for frontline health care workers.
T29 6045-6052 Sentence denotes Funding
T30 6053-6074 Sentence denotes No financial support.
T31 6076-6098 Sentence denotes Disclosure of interest
T32 6099-6156 Sentence denotes The authors declare that they have no competing interest.