|
If there is a shortage of Intensive Care beds or ventilators in a pandemic, then physicians in the hospital should decide who would receive or who should be denied those lifesaving resources.
|
|
|
|
We need to have public policies to assure fairness in the allocation of scarce life‐saving resources during a pandemic, not the subjective judgments of individual physicians.
|
|
|
|
A non‐partisan committee of experts, both medical and non‐medical, should have primary responsibility for creating public policies for allocating scarce life‐saving resources during a pandemic.
|
|
|
|
Difficult ethics issues must be addressed and ethical trade‐offs will need to be made as part of formulating any policies regarding allocating lifesaving resources in a pandemic.
|
|
|
|
The ethics issues that need to be addressed in these policies should reflect the views of citizens who would potentially be affected by these policies; hence, there should be broad public involvement in determining these policies informed by the views of various experts.
|
|
|
|
Public engagement in fashioning these allocation policies is necessary to build public trust and to give them political legitimacy.
|
|
|
|
Our first ethical principle in shaping these allocation policies is that all citizens must be treated as having equal rights; no special access should be given to lifesaving resources for those who are wealthy or politically connected or socially prominent.
|
|
|
|
Individuals with health insurance who can pay for their care should have priority for lifesaving resources over uninsured individuals who cannot pay for their care.
|
|
|
|
We understand that not everyone can be saved whose life might be at risk during an academic. We should give highest priority for lifesaving resources to those who are most ill AND who are also most likely to benefit from having those lifesaving resources.
|
|
|
|
Patients with the highest probability of dying soon should be denied scarce resources in order to benefit patients with a higher likelihood of survival.
|
|
|
|
Patients who are extremely ill in a pandemic and who will require very prolonged use of an ICU bed or a respirator should be given lower priority for using these resources than individuals who are likely to recover more quickly, thereby making that resource available to more patients.
|
|
|
|
Patients with various disabilities, such as being blind or deaf or paralyzed, should have equal rights to lifesaving resources in a pandemic as patients who have no disabilities.
|
|
|
|
Patients with end‐stage dementia are often regarded as persons with disabilities, but such patients should have only very low priority for scarce lifesaving resources during a pandemic.
|
|
|
|
Very high priority for scarce lifesaving resources should be given to health care professionals caring for patients in a pandemic if they themselves become infected as long as they are likely to recover.
|
|
|
|
If family members of health care professionals caring for pandemic patients are at increased risk of infection from the health professional, then they too deserve high priority for access to scarce lifesaving resources as long as they are likely to recover.
|
|
|
|
If we have too many patients with good chances of survival and too few ICU beds or respirators, then priority ought to go to relatively younger patients.
|
|
|
|
If we have too many patients with good chances of survival and too few ICU beds or respirators, then a lottery should determine who gets the ICU bed or respirator.
|
|
|
|
In a severe pandemic I would endorse excluding from a critical care unit any patient who had suffered severe trauma, such as serious brain injury from a car accident, requiring extensive use of lifesaving resources.
|
|
|
|
In a severe pandemic I would endorse excluding from a critical care unit any patient who had metastatic cancer with poor prognosis.
|
|
|
|
In a severe pandemic I would endorse excluding from a critical care unit any patient who had suffered end‐stage organ failure, such as a severely damaged heart or liver.
|
|
|