Resource scarcity and allocation criteria during the Covid-19 pandemic: Ethical issues

Abstract

The increase in cases of patients needing to be admitted to intensive care, due to Covid-19 infection, has led to a strong imbalance between available resources and healthcare requirements. Therefore, the determination of further criteria, in addition to those of clinical appropriateness and proportionality of care, to define the allocation of the limited resources available was necessary. For these reasons, in March 2020, the SIAARTI (Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care) published a document containing the “Clinical Ethics Recommendations for the Allocation of Intensive Care Treatments, in exceptional, resource-limited circumstances,” to relieve clinicians from a part of the responsibility in the decision-making process, which can be emotionally burdensome, carried out in individual cases and to make the allocation criteria for healthcare resources explicit in a condition of their own extraordinary scarcity.

Working in value‐discrepant environments inhibits clinicians’ ability to provide compassion and reduces well‐being: A cross‐sectional study

“…Our findings suggest that addressing the incongruence between personal and perceived organizational values could be of considerable benefit to healthcare organizations. The current climate of austerity and uncertainty [44] combined with the additional service demands created by the COVID‐19 pandemic [45] suggest that healthcare organizations will be striving for even greater efficiency and cost savings. Discrepancies in values are also likely to be exacerbated by variations in resource allocation [100] and increasing resource scarcity [45].…”

“…Similar values are signalled by healthcare organizations [40][41][42][43]. However, little is known about how organizational values are actualized, especially when fiscal austerity and uncertainty [44] coupled with increased service demands [45] may lead to "mission drifts" where external pressures can shift organizational vision, values and goals from humanistic to more operational concerns [46][47][48]. Theoretically, engaging in behaviours that are inconsistent with personal values (PVs) and beliefs can undermine personal and professional functioning [49], create a "stress of conscience" [50,51] and underpin moral distress [52].…”

Working in values-discrepant environments inhibits clinicians’ ability to provide compassion and reduces wellbeing: a cross-sectional study

“…Our findings suggest that addressing the incongruence between personal and perceived organisational values could be of considerable benefit to healthcare organisations. The current climate of austerity and uncertainty 43 combined with the additional service demands created by COVID-19 pandemic 44 suggest that healthcare organisations will be striving for even greater efficiency and cost savings. Discrepancies in values are likely to be exacerbated by variations in resource allocation 109 and increasing resource scarcity.…”

“…Discrepancies in values are likely to be exacerbated by variations in resource allocation 109 and increasing resource scarcity. 44 In fact, this dynamic was already clearly seen in evidence during the rationalisation of health care resourcing that occurred during COVID-19 and by making decisions about who gets health care during COVID-19, in what ways, and how it would affect clinicians. [136][137][138][139][140][141] Unfortunately, again, the value set informing those discussions and the resultant algorithms have shown to be more 'business as usual', process-orientated, tokenistic and inequitable, likely worsening the pre-existing tensions between organisational values and those of the healthcare workforce.…”

“…[36][37][38] Healthcare organisations are likely to signal similar humanistic values in public communications. [39][40][41][42] However, little is known about how these values are actualized within these organisations, especially when fiscal austerity and uncertainty 43 coupled with the increased service demands exacerbated by the global Covid-19 pandemic 44 may have led to a "mission drift" where external pressures shift organisational vision, values, and goals from humanistic to more operational concerns. [45][46][47] Again, some works imply that "business-oriented" environments that value efficiency, busy-ness, and emotional toughness can inhibit compassion.…”