Leaving No Ethical Value Behind: Triage Protocol Design for Pandemic Rationing

Pathak, Parag A.; Sönmez, Tayfun; Ünver, M. Utku; Yenmez, M. Bumin

doi:10.3386/w26951

Cited by 25 publications

(26 citation statements)

References 14 publications

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“…So-called reserve systems have been used to ensure that ‘colourblind’ assessments (focusing exclusively on ‘objective’ entry examination results) no longer disproportionately privilege the better-off, but also provide allocations for worse-off populations, with recent adaptations for ventilator rationing. 47 Equity weights can instantly eliminate John’s unfair advantage, and James’ and Martin’s unfair disadvantage. While practically straightforward, the strongest challenge is a legal one.…”

Section: The Way Forwardmentioning

confidence: 99%

Rationing, racism and justice: advancing the debate around ‘colourblind’ COVID-19 ventilator allocation

2021

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Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities—who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey’s Crisis Standard of Care policy, we describe how dominant rationing guidance compounds for many Black patients prior unfair structural disadvantage, chiefly due to the way creatinine and life expectancy are typically considered.We outline six possible policy options towards a more just approach: improving diversity in decision processes, adjusting creatinine scores, replacing creatinine, dropping creatinine, finding alternative measures, adding equity weights and rejecting the dominant model altogether. We also contrast these options with making no changes, which is not a neutral default, but in separate need of justification, despite a prominent claim that it is simply based on ‘objective medical knowledge’. In the regrettable absence of fair federal guidance, hospital and state-level policymakers should reflect on which of these, or further options, seem feasible and justifiable.Irrespective of which approach is taken, all guidance should be supplemented with a monitoring and reporting requirement on possible disparate impacts. The hope that we will be able to continue to avoid rationing ventilators must not stand in the way of revising guidance in a way that better promotes health equity and racial justice, both to be prepared, and given the significant expressive value of ventilator guidance.

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Section: The Way Forwardmentioning

confidence: 99%

Rationing, racism and justice: advancing the debate around ‘colourblind’ COVID-19 ventilator allocation

2021

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“…5 Specifically, due to the threat of their shortage and their potential lifesaving nature, the decision to allocate or reallocate ventilators is accompanied by serious medical and ethical dilemmas. [5][6][7][8] In order to attain a fair allocation of scarce resources while responding rapidly and effectively to the crisis, guidelines and protocols have been developed in many countries. A recent review of 27 relevant guidelines published in different states in the US showed that the majority of them do not give priority to any specific group for the allocation of ventilators.…”

Section: Introductionmentioning

confidence: 99%

Laypersons’ Priority-Setting Preferences for Allocating a COVID-19 Patient to a Ventilator: Does a Diagnosis of Alzheimer’s Disease Matter?

Werner¹,

Landau²

2020

CIA

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Purpose The current study aimed 1) to assess laypersons’ priority-setting preferences for allocating ventilators to COVID-19 patients with and without AD while differentiating between a young and an old person with the disease, and 2) to examine the factors associated with these preferences. Methods A cross-sectional online survey was conducted among a sample of 309 Israeli Jewish persons aged 40 and above. Results Overall, almost three quarters (71%) of the participants chose the 80-year-old patient with a diagnosis of AD to be the last to be provided with a ventilator. The preferences of the remaining quarter were divided between the 80-year-old person who was cognitively intact and the 55-year-old person with AD. Education and subjective knowledge about AD were significantly associated with participants’ preferences. Conclusion Our results suggest that cognitive status might not be a strong discriminating factor for laypersons’ preferences for allocating ventilators during the COVID-19 pandemic.

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“…4 However, one limitation of the point system is that it does not optimise for multiple competing values and applies the same fixed criteria for all subgroups, some of which may not benefit from it. 5 For example, sicker patients may never receive ventilators under a point system, as they are 'too sick' and thus could never get good enough scores to qualify.…”

Section: Using Decision Analysis To Operationalise Prioritisationmentioning

confidence: 99%

“…An alternative decision method used in allocating scarce care resources is the reserve system, whereby allocations are established for protected classes. 5 For example, a certain number of surgical cases per week may be reserved for particular groups, such as Good Samaritans, essential personnel and disabled individuals. Yet, the allocation decisions in the reserve system present their own set of ethical and implementation challenges.…”

Section: Using Decision Analysis To Operationalise Prioritisationmentioning

confidence: 99%

Prioritising surgical cases deferred by the COVID-19 pandemic: an ethics-inspired algorithmic framework for health leaders

Jain

Dai

Myers

et al. 2021

leader

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Elective surgical suspension during the COVID-19 pandemic resulted in a sizeable surgical case backlog throughout the world. As we ramp back up, how do we decide which cases take priority? Potential future waves (or a future pandemic) may lead to additional surgical shutdown and subsequent reopening. Deciding which cases to prioritise in the face of limited health system capacity has emerged as a new challenge for healthcare leaders. Here we present an ethically grounded and operationally efficient surgical prioritisation framework for healthcare leaders and practitioners, drawing insights from decision analysis and organisational sciences.

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Leaving No Ethical Value Behind: Triage Protocol Design for Pandemic Rationing

Cited by 25 publications

References 14 publications

Rationing, racism and justice: advancing the debate around ‘colourblind’ COVID-19 ventilator allocation

Rationing, racism and justice: advancing the debate around ‘colourblind’ COVID-19 ventilator allocation

Laypersons’ Priority-Setting Preferences for Allocating a COVID-19 Patient to a Ventilator: Does a Diagnosis of Alzheimer’s Disease Matter?

Prioritising surgical cases deferred by the COVID-19 pandemic: an ethics-inspired algorithmic framework for health leaders

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