In this single-center cohort study, the guardianship process was associated with prolonged hospital stay and higher total hospital charges even when compared with matched controls. Furthermore, one in six patients suffered from a hospital-associated complication after medical clearance.
IMPORTANCE Crisis standards of care (CSOC) scores designed to allocate scarce resources during the COVID-19 pandemic could exacerbate racial disparities in health care.OBJECTIVE To analyze the association of a CSOC scoring system with resource prioritization and estimated excess mortality by race, ethnicity, and residence in a socially vulnerable area.
DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort analysis included adult patients in the intensive care unit during a regional COVID-19 surge from April 13 to May 22, 2020, at 6 hospitals in a health care network in greater Boston, Massachusetts. Participants were scored by acute severity of illness using the Sequential Organ Failure Assessment score and chronic severity of illness using comorbidity and life expectancy scores, and only participants with complete scores were included. The score was ordinal, with cutoff points suggested by the Massachusetts guidelines.
This article addresses all of the issues involved in the debate about whether or not bioethicists should be paid by private biomedical companies to perform consultations. These issues include the following: differentiation of this role from bioethicists' other roles, an analysis of to whom bioethicists owe a duty, consideration of what bioethicists are "selling," whether bioethicists should be allowed to get paid, when payment becomes problematic, and whether consulting fee arrangements should be regulated. The author often compares bioethicists' relationship to the companies to bioethicists' other relationships, as well as to professional relationships in other fields, such as law and accounting.
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