Age discrimination in critical care triage in South Africa: The law and the allocation of scarce health resources in the COVID-19 pandemic

Erasmus, N

doi:10.7196/samj.2020.v110i12.15344

Cited by 17 publications

(10 citation statements)

References 20 publications

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“…The COVID-19 pandemic demonstrates that having such a framework would have been helpful in making a number of critical decisions, for example in the pricing, procurement and allocation of vaccines, treatments, oxygen and critical care beds for COVID-19, as well as for procurement and allocation of personal protective equipment. [24][25][26] In the context of a constrained budget and severe hardship caused by the pandemic, going forward, careful priority-setting using local ethics and values is essential. This Framework will assist this process.…”

Section: Discussionmentioning

confidence: 99%

Introducing an Ethics Framework for health priority-setting in South Africa on the path to universal health coverage

Blaauw

Chambers

Chirwa

et al. 2022

SAMJ

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Background. South Africa (SA) has embarked on a process to implement universal health coverage (UHC) funded by National Health Insurance (NHI). The 2019 NHI Bill proposes creation of a health technology assessment (HTA) body to inform decisions about which interventions NHI funds will cover under UHC. In practice, HTA often relies mainly on economic evaluations of cost-effectiveness and budget impact, with less attention to the systematic, specific consideration of important social, organisational and ethical impacts of the health technology in question. In this context, the South African Values and Ethics for Universal Health Coverage (SAVE-UHC) research project recognised an opportunity to help shape the health priority-setting process by providing a way to take account of multiple, ethically relevant considerations that reflect SA values. The SAVE-UHC Research Team developed and tested an SA-specific Ethics Framework for HTA assessment and analysis. Objectives. To develop and test an Ethics Framework for use in the SA context for health priority-setting. Methods. The Framework was developed iteratively by the authors and a multidisciplinary panel (18 participants) over a period of 18 months, using the principles outlined in the 2015 NHI White Paper as a starting point. The provisional Ethics Framework was then tested with multi-stakeholder simulated appraisal committees (SACs) in three provinces. The membership of each SAC roughly reflected the composition of a potential SA HTA committee. The deliberations and dedicated focus group discussions after each SAC meeting were recorded, analysed and used to refine the Framework, which was presented to the Working Group for review, comment and final approval. Results. This article describes the 12 domains of the Framework. The first four (Burden of the Health Condition, Expected Health Benefits and Harms, Cost-Effectiveness Analysis, and Budget Impact) are commonly used in HTA assessments, and a further eight cover the other ethical domains. These are Equity, Respect and Dignity, Impacts on Personal Financial Situation, Forming and Maintaining Important Personal Relationships, Ease of Suffering, Impact on Safety and Security, Solidarity and Social Cohesion, and Systems Factors and Constraints. In each domain are questions and prompts to enable use of the Framework by both analysts and assessors. Issues that arose, such as weighting of the domains and the availability of SA evidence, were discussed by the SACs. Conclusions. The Ethics Framework is intended for use in priority-setting within an HTA process. The Framework was well accepted by a diverse group of stakeholders. The final version will be a useful tool not only for HTA and other priority-setting processes in SA, but also for future efforts to create HTA methods in SA and elsewhere.

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Section: Discussionmentioning

confidence: 99%

Introducing an Ethics Framework for health priority-setting in South Africa on the path to universal health coverage

Blaauw

Chambers

Chirwa

et al. 2022

SAMJ

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“…One way this played out was through the issuing of guidelines and decision tools around the world which were ageist and or ableist [57][58][59]. These clinical decisions tools compounded governments' often slow responses to provide the additional care required by these groups [60], even though it was clear from the start of the pandemic that they were at higher risk (as were people from certain ethnic backgrounds -both patients and staff).…”

Section: Equitymentioning

confidence: 99%

Social Work Leadership for Patient Safety

Travaglia¹

2023

Social Work - Perspectives on Leadership and Organisation

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Social workers are rarely considered as key personnel in the field of patient safety. The clinical nature of many, if not most, errors means that it is much more likely that doctors, nurses and pharmacists are involved both in the errors themselves and in attempts to improve the quality and safety of care. Yet, despite best efforts around the world for the last two decades the overall rate of errors has not decreased. In this chapter I argue that there is great potential for social work leadership to improve the quality and safety of care for patients and clients, and in particular for vulnerable individuals and groups. One way of understanding this potential is through the lens of a social epidemiology of patient safety, which can then be linked to the competencies required by social workers in leading this new approach to patient/client safety and quality improvement. Drawing on evidence both from research and from patient safety inquiries around the world, I look at how the social context and status of patients contributes to errors, particularly of vulnerable individuals and groups, and the unique leadership role that social workers can take in preventing and responding to errors and adverse events.

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“…The novel coronavirus disease 2019 (COVID-19) pandemic has brought to the fore many ethical questions about rationing of limited healthcare resources. Implementation of critical care triage guidelines might discriminate against older adults and individuals with cognitive or physical impairments ( 2 ). This is especially concerning when ~15% of the global population of adults 60 years of age and older have a mental disorder ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Ageism, human rights and ethical aspects of end-of-life care for older people with serious mental illness

Kotzé

Roos

2022

Front. Psychiatry

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There are many complex concepts to consider during end-of-life discussions and advance care planning, especially when vulnerable populations such as older individuals with serious mental illness are involved. This article aims to summarize some of these important concepts, such as the effects of ageism, preservation of human rights and dignity, supported or shared decision making and palliative approaches. It emerged from a study that found two thirds of 100 participants 60 years of age and older with serious mental illness had end-of-life decision-making capacity. This finding highlighted the individual and contextual nature of decision-making capacity, the importance of consideration of individual values and protection of human dignity during end-of-life care. Healthcare providers have a duty to initiate end-of-life and advance care discussions, to optimize decision-making capacity, and to protect autonomous decision-making. Chronological age or diagnostic categories should never be used as reasons for discrimination and all patients should receive end-of-life care in keeping with their preferences and values.

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Age discrimination in critical care triage in South Africa: The law and the allocation of scarce health resources in the COVID-19 pandemic

Cited by 17 publications

References 20 publications

Introducing an Ethics Framework for health priority-setting in South Africa on the path to universal health coverage

Introducing an Ethics Framework for health priority-setting in South Africa on the path to universal health coverage

Social Work Leadership for Patient Safety

Ageism, human rights and ethical aspects of end-of-life care for older people with serious mental illness

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