Physician viewpoint: It's too soon to say crisis standards of care are free of racial bias

The U.S. healthcare system must ensure crisis standards of care do not exacerbate racial inequities, three emergency medicine physicians wrote in a March 19 commentary published in JAMA Network Open.

The article's authors are:

  • Emily Cleveland Manchanda, MD, assistant professor of emergency medicine at the Boston University School of Medicine and emergency physician at Boston Medical Center. 
  • Melanie Molina, MD, emergency medicine resident at Massachusetts General Hospital in Boston.
  • Robert Rodriguez, MD, a professor of emergency medicine at University of California, San Francisco's medical school and an emergency physician at San Francisco General Hospital.

The physicians' commentary is in response to a study also published March 19 in JAMA Network Open, which found resource allocation using crisis standards of care guidelines did not appear to discriminate against patients based on their race or ethnicity at two Miami hospitals.

"Although these findings suggest that CSC guidelines may not exacerbate the existing racial inequities in our healthcare system, it is critical to consider them in the broader context of [two] ongoing pandemics: COVID-19 and U.S. racism," the emergency physicians wrote.

For example, many underprivileged communities of color rely on safety-net hospitals for care, which are more likely to face resource constraints and rely on government funding. These constraints could cause compromised care even before crisis standards of care are implemented, they said. 

To prevent these guidelines from further compounding racial disparities, Drs. Manchanda, Molina and Rodriquez said resource allocation criteria should be "developed, revised and implemented through an identity-conscious lens."

"If we are forced to activate CSC guidelines for critical care resource allocation, we must ensure that they equitably serve our most marginalized and at-risk populations," they concluded. "Further prospective and validation studies are needed before CSC can be deemed free of racial and other biases."

To view the full commentary, click here.

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