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코로나 19로 인한 자원 부족 상황에서 의료 자원의 배분 정의

How Should Scarce Healthcare Resources be Rationed during the COVID-19 Pandemic?

이경도
한국의료윤리학회 (The Korean Society For Medical Ethics)|2020.09|한국의료윤리학회지 (Korean Journal of Medical Ethics)|제23권 제3호|pp. 145-169|DOI 10.35301/ksme.2020.23.3.145

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COVID-19코로나 19medical ethicsdistributive justice의료윤리보건윤리public health ethics배분 정의의료 자원 배분인구 수준 생명윤리health care rationingpopulation-level bioethics
주제분류의학일반

초록

현재 대부분 전문가가 코로나 19의 2차 대유행이 곧 올 것이라 예상하고 있다. 만약 2차 대유행이 온다면, 혹은 그 이후에도 대유행이 다시 온다면, 발생할 다수의 코로나 19 환자를 치료하기 위한 중환자실 병상과 인공호흡기가 극히 부족해 질 것으로 보인다. 극심한 의료 자원 부족 상황에서 누구를 먼저 살리고 누구를 치료하지 않을 것인지 결정하기 위해서는 분명 배분 정의와 관련된 논의가 필요하다. 본 논문은 먼저 최대한 많은 사람을 살리기 위한 의료 자원의 배분은 몇 가지 조건 하에서는 개개인의 권리를 동일하게 대우한다는 근거로 충분히 공정하다는 것을 밝힐 것이다. 그러나 이후 의료 자원의 모든 배분 결정이 많은 사람을 살리기 위해 이루어지는 것이 정당하지 않은 경우 또한 밝힐 것이다. 그 후 실제 코로나 19 환자들에게 의료 자원을 배분할 경우 살릴 수 있는 사람들의 수 외에 고려해야 할 여러 사항(연령, 장애 및 중증도, 의료진 및 타인에게 혜택을 주는 이들, 건강 및 사회경제적 불평등, 기타 사항)을 어떻게 배분 결정에 포함시킬 것인지 논의한다. 그 논의 과정에서, 미국에서 이미 적용 중인 여러 의료 자원 배분 지침은 어떤 윤리적 논거와 가치에 기반하고 있는지도 살펴볼 것이다. 무엇보다 본 논문은 관련된 모든 논쟁을 해결하려고 하기보다, 넓게 동의할 수 있는 합리적인 방식의 배분은 어떤 것일지 정리해본다는 목표를 지니고 있다.

Abstract

Experts have been warning of a second wave of COVID-19 infections that is expected to occur within the next two months. If this prediction comes true, the demand for ventilators, intensive care units, and other healthcare resources may be greater than the supply, raising questions of distributive justice and the rationing of scarce healthcare resources. This article summarizes some of the theoretical issues associated with distributive justice, examines the ethical basis of the rationing principles that have been adopted by certain hospitals in the United States, and attempts to identify common ground that might facilitate broad agreement concerning the principles that should guide resource-allocation decisions during this pandemic. The article aims to show, firstly, that from the perspective of a non-utilitarian, rights-based theory, it is fair or just to allocate life-saving resources in ways that save the greatest number of lives. Nevertheless, it is also argued that there are several other factors need to be considered in the rationing of healthcare resources, including a patient’s age, disability status, health condition, occupation, time of admission to a health care facility, and whether the patient’s disease is COVID-19.

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