Awareness of ethical dilemmas enhances public support for the principle of saving more lives in the United States: A survey experiment based on ethical allocation of scarce ventilators

Rai, Birendra; Wang, Liang Choon; Pandit, Simone; Handfield, Toby; So, Chiu Ki

doi:10.1016/j.socscimed.2021.114171

Cited by 4 publications

(10 citation statements)

References 24 publications

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“…Another study included participants from both the USA and Canada [41]. Other studies conducted public consultation with a speci c population: 4 studies from the USA [42,43,44,45]; 3 from the UK [46, 47, 48]; 2 from Iran [49,50]; 2 from Australia [51,52]; 1 study from each of the following countries: Italy [53], Switzerland [54], Netherlands [55]; Portugal [56], Thailand [57], Japan [58], and Korea [59].…”

Section: Resultsmentioning

confidence: 99%

“…Intergenerational equity has been considered and discussed in several public consultations (90%) [44,45,46,47,50,51,52,55,56,58,59]. This type of equity is part of the equity concepts related to health outcomes, represented by the "fair innings" argument when considering the criterion of the human life cycle [62].…”

Section: Intergenerational Equitymentioning

confidence: 99%

“…Likewise, we found one study where this meant for participants to categorically exclude patients with limited remaining years of life (e.g., very old patients with very severe comorbidities) [45]. In Thailand there is a calculation for this: the "number of years of life saved" is obtained by calculating the life expectancy at birth minus the current age of the patient [57].…”

Section: Absolute Agementioning

confidence: 99%

“…In Thailand there is a calculation for this: the "number of years of life saved" is obtained by calculating the life expectancy at birth minus the current age of the patient [57]. One study showed that the public would take this principle into account under the premise of maximizing bene ts, but only as a tiebreaker [45].…”

Section: Absolute Agementioning

confidence: 99%

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Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review

Ramirez

Farmer

Bouthillier

2023

Preprint

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Background To reduce the arbitrariness in the allocation of rare resources in intensive care units (ICU) in the context of the pandemic, tiebreakers were considered in some COVID-19 triage algorithms. They were also contemplated to facilitate the tragic decisions of healthcare workers when faced with two patients with similar prognosis and only one ICU bed available. Little is known about the public's perspective on tiebreakers. Objectives To consolidate the available scientific literature on public consultations, particularly on tiebreakers and their underlying values. Also, to obtain an overview of the key arguments presented by the participating public and to identify potential gaps related to this topic. Methods The steps described by Arksey & O'Malley was the preferred method to our approach. Seven electronic databases were searched from January 2020 to April 2022, using keywords for each database: PubMed, Medline, EMBASE, Web of Science, PsycINFO, EBM reviews, CINAHL complete. We also searched in Google and Google Scholar, and in the references of the articles found. Our analysis was mainly qualitative. A thematic analysis was performed to consider the public's perspectives on tiebreakers and their underlying values, according to these studies. Results Of 477 publications found, 20 were selected. They carried out public consultations through various methods: surveys (80%), interviews (20%), deliberative processes (15%) and others (5%) in various countries: Australia, Brazil, Canada, China, France, Germany, India, Iran, Italy, Japan, Korea, Netherlands, Portugal, Spain, Switzerland, Thailand, United Kingdom, and United States. Five themes emerged from our analysis. The public favored the life cycle (50%) and absolute age (45%) as a tiebreaker. Other values considered important were reciprocity, solidarity, equality, instrumental value, patient merit, efficiency, and stewardship. Among the new findings were a preference for patient nationality and those affected by COVID-19. Conclusions There is a preference for favoring younger patients over older patients when there is a tie between similar patients, with a slight tendency to favor intergenerational equity. Variability was found in the public's perspectives on tiebreakers and their values. This variability was related to socio-cultural and religious factors. More studies are needed to understand the public's perspective on tiebreakers.

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Section: Resultsmentioning

confidence: 99%

Section: Intergenerational Equitymentioning

confidence: 99%

Section: Absolute Agementioning

confidence: 99%

Section: Absolute Agementioning

confidence: 99%

See 2 more Smart Citations

Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review

Ramirez

Farmer

Bouthillier

2023

Preprint

View full text Add to dashboard Cite

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“…This feature likely encourages participants to think about the views of others, rather than their own personal preferences. The choices made in the coordination task reveal what people with potentially different personal preferences are most likely to collective agree upon 29 .…”

Section: Methodsmentioning

confidence: 99%

Public support in the United States for global equity in vaccine pricing

Chan

Datt

Islam

et al. 2022

Sci Rep

Self Cite

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Global vaccine prices that are tiered across countries, equitable for poorer countries, and profitable for manufacturers (TEP) can promote global vaccine equity but its implementation may require political will and public support in rich countries. A survey experiment with a demographically representative sample of US adults was conducted between April and May 2021 to investigate public support for TEP and the likelihood of collective agreement on TEP relative to alternative global vaccine pricing strategies. The experiment varied vaccine cost and provision of information about the importance of equity and profitability considerations in global vaccine pricing across eight treatment conditions. TEP of low-cost vaccines received less support than TEP of high-cost vaccines, but TEP received more public support than any alternative pricing strategy. Information about equity and profitability considerations increased support for TEP of low-cost vaccines. TEP was also the most likely pricing strategy to achieve collective agreement among participants across all treatments.

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Health Professional vs Layperson Values and Preferences on Scarce Resource Allocation

Buhr,

Huynh,

Lee

et al. 2024

JAMA Netw Open

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ImportanceCOVID-19 prompted rapid development of scarce resource allocation (SRA) policies to be implemented if demand eclipsed health systems’ ability to provide critical care. While SRA policies follow general ethical frameworks, understanding priorities of those affected by policies and/or tasked with implementing them is critical.ObjectiveTo evaluate whether community members and health care profesionals (HCP) agree with SRA protocols at the University of California (UC).Design, Setting, and ParticipantsThis survey study used social media and community-partnered engagement to recruit participants to a web-based survey open to all participants aged older than 18 years who wished to enroll. This study was fielded between May and September 2020 and queried participants’ values and preferences on draft SRA policy tenets. Participants were also encouraged to forward the survey to their networks for snowball sampling. Data were analyzed from July 2020 to January 2024.Main Outcomes and MeasuresSurvey items assessed values and preferences, graded on Likert scales. Agreement was tabulated as difference in Likert points between expressed opinion and policy tenets. Descriptive statistics were tested for significance by HCP status. Free text responses were analyzed using applied rapid qualitative analysis.ResultsA total of 1545 participants aged older than 18 years (mean [SD] age 49 [16] years; 1149 female participants [74%], 478 health care practitioners [30%]) provided data on SRA values and preferences. Agreement with UC SRA policy as drafted was moderately high among respondents, ranging from 67% to 83% across domains. Higher agreement with the interim policy was observed for laypersons across all domains except health-related factors. HCPs agreed more strongly on average that resources should not be allocated to those less likely to survive (HCP mean, 3.70; 95% CI, 3.16-3.59; vs layperson mean, 3.38; 95% CI, 3.17-3.59; P = .002), and were more in favor of reallocating life support from patients less likely to those more likely to survive (HCP mean, 6.41; 95% CI, 6.15-6.67; vs layperson mean, 5.40; 95% CI, 5.23-5.58; P &lt; .001). Transparency and trust building themes were common in free text responses and highly rated on scaled items.Conclusions and RelevanceThis survey of SRA policy values found moderate agreement with fundamental principles of such policies. Engagement with communities affected by SRA policy should continue in iterative refinement in preparation for future crises.

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Awareness of ethical dilemmas enhances public support for the principle of saving more lives in the United States: A survey experiment based on ethical allocation of scarce ventilators

Cited by 4 publications

References 24 publications

Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review

Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review

Public support in the United States for global equity in vaccine pricing

Health Professional vs Layperson Values and Preferences on Scarce Resource Allocation

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