Ethical resource allocation in the age of COVID-19: 6 tips

In the midst of pandemics, healthcare workers face a wide array of pressures, including the pressure to ensure they are making ethical decisions with regard to resources in the face of a crisis.

In an article published in the New England Journal of Medicine, a group of international experts on medical ethics and health policy offered six recommendations to ensure patients receive equal treatment and scarce resources are allocated ethically during the COVID-19 pandemic, which has sickened approximately 490,000 and killed around 22,000 worldwide.

Here are six expert recommendations:

1. Give priority to patients who are sick but could recover over patients who are unlikely to recover even if treated.

"Because maximizing benefits is paramount in a pandemic, we believe that removing a patient from a ventilator or an ICU bed to provide it to others in need is also justifiable and that patients should be made aware of this possibility at admission," they wrote.

2. Critical services and resources related to stemming the COVID-19 pandemic, such as testing, personal protective equipment, intensive care unit beds and ventilators, should go first to front-line healthcare workers and others who care for ill patients.

"These workers should be given priority, not because they are somehow more worthy, but because of their instrumental value. They are essential to pandemic response," the authors wrote.

3. Care services should be randomly allocated to COVID-19 patients who are expected to have similar outcomes, rather than on a first-come, first-served basis. A first-come, first-served approach would unfairly benefit patients who live close to hospitals, encourage crowding, or even violence, when drugs or vaccines are being distributed and potentially exclude from treatment people who become sick later on in the pandemic timeline.

"First-come, first-served is used for such resources as transplantable kidneys, where scarcity is long-standing and patients can survive without the scarce resource. Conversely, treatments for coronavirus address urgent need," the authors wrote.

4. When a vaccine becomes available, healthcare workers and first responders should be given priority with regard to getting the vaccine, followed by older adults.

"Invoking the value of maximizing saving lives justifies giving older persons priority for vaccines immediately after healthcare workers and first responders," they wrote.

5. People who participate in research to prove the safety and effectiveness of vaccines and therapies should receive some priority for COVID-19 treatments.

"Their assumption of risk during their participation in research helps future patients, and they should be rewarded for that contribution," they wrote. But, research participation, "should serve only as a tiebreaker among patients with similar prognoses."

6. There should not be a difference in allocating scarce resources between COVID-19 patients and those with other medical conditions.

"If the COVID-19 pandemic leads to absolute scarcity, that scarcity will affect all patients, including those with heart failure, cancer and other serious and life-threatening conditions requiring prompt medical attention," the authors wrote.

More articles on integration and physician issues:
Nearly half of surveyed primary care practices say they don't have capacity for COVID-19 testing
Physicians take drastic measures to protect families from coronavirus
Primary care recruitment: How 3 organizations are moving the needle

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