Ethics of Pandemics: Ethics of Ventilator Allocation
From a lecture on the ethics of pandemics by Jessica Miller, a philosophy professor at Maine, watch the sub-section from 17:18-27:37 on the ethics of ventilator allocation:
Segment 19:40-22:00 covers 6 potential allocation strategies:
1 - first come, first served
2 - sickest first
3 - best prognosis
4 - youngest first
5 - instrumental value to society
6 - lottery
22:00-25:36 goes through one example of a potential allocation strategy taken from Maryland:
1 - exclude certain people
2 - life expectancy (both short- and long-term survival)
3 - stage of life-cycle
The section then goes through a few sample scenarios to think through. It ends with the important points that our care for a patient, their family, staff, and the community doesn’t end with deciding a patient doesn’t get a ventilator. It is also important to be transparent with the community at large.
How Will Doctors Allocate Scarce Medical Resources During the COVID-19 Coronavirus Pandemic?
Read this article by Paul Hsieh in Forbes:
Prioritize patients with highest chance of survival; lower priorities: patients unlikely to survive with or without treatment, and patients likely to survive without treatment.
Use a triage committee not involved in taking care of the patient.
Maximize benefits, whether number of patients or total years of life.
Should healthcare workers be prioritized? One rationale would be so that they can recuperate and reenter the workforce.
Should patients be asked if they’d be willing to forgo their ventilator if someone who is higher priority needs it more?
In a coronavirus crisis, who deserves a ventilator?
Read this article co-authored by over a dozen doctors in USA Today:
In the U.S., we have ingrained in us the idea of patients being allowed to choose which treatment(s) they get, without thinking about community needs, efficacy, finances, or ethics. During pandemics, stewarding limited resources becomes an ethical duty.
The ventilator should go not only to someone who needs it, but someone who wants it and is likely to survive as a result of the resource.
What shouldn’t be a factor? Finances, insurance status, disability, “social worth.”
Additional resources
Gawande
Watch this video on coronavirus featuring a newcaster’s interview with Dr Atul Gawande, author of the New Yorker article Keeping the Coronavirus From Infecting Healthcare Workers:
1-Recognize that it’s a national epidemic
2-Shelter in place on a national level
3-Physical distancing
4-Tracing and containing contacts. You only need to quarantine those with whom you had contact for >30 minutes, less than 6 feet away, and without a surgical mask.
Symptoms: Fever, new cough, new shortness of breath, loss of taste, new muscle aches.
While the interview is more on coronavirus in general, the latter half does touch tangentially other bigger ethical issues that can arise, including the cost of social distancing to the community as a whole, and the ethics of working without adequate PPE:
Starting at minute 5, Gawande addresses whether the adage “sometimes the cure is worse than the disease” applies in the coronavirus pandemic. He notes that letting the virus “run its course” won’t prevent or decrease the thousands of people from getting sick and the economy would be even more worse off.
PPE, especially masks and gloves are crucial in protecting healthcare workers.
NEJM, Truog et al.
The Toughest Triage – Allocating Ventilators in a Pandemic
https://www.nejm.org/doi/full/10.1056/NEJMp2005689
Fair Allocation of Scarce Medical Resources in the time of Covid-19