Ethics Roundtable: Distribution of Critical Care Resources in the Setting of a COVID-19 Surge

Baumrucker, Steven J.; Carter, Gregory T.; Adkins, Russel W; Perkins, Cheryl L.; Stolick, Matt; VandeKieft, Gregg

doi:10.1177/1049909120951084

Cited by 3 publications

(3 citation statements)

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“…During times of crisis and scarce resources, this concept still applies, even when introducing measures such as triage. Thus, the greatest good of critical- and intensive care facilities can be allocated to eligible patients, therefore maximizing life years saved [ 2 ]. The focus should of course lie on the patients' individual autonomy when raising questions like “What would you want to happen if your health gets worse during your COVID-19 illness?” .…”

Section: The Patients' Perspectivementioning

confidence: 99%

“…The focus should of course lie on the patients' individual autonomy when raising questions like “What would you want to happen if your health gets worse during your COVID-19 illness?” . Under conventional care conditions, self-determination is a basic right; however, during a crisis, public interests may supersede individual liberty [ 2 , 3 ]. In addition, patients likely overestimate the success rate of interventions such as resuscitative attempts, rendering them poorly prepared for end-of-life situations [ 4 ].…”

Section: The Patients' Perspectivementioning

confidence: 99%

“…Acknowledging resource constraints when discussing goals of care, the potential need for triage decisions, and the safety of medical personnel justifying selective constraints on intensive care measures round up the picture of a huge burden for all parties involved. Emotional support and spiritual care can be offered for some alleviation [ 2 ]; however, in the post-crisis period, these lessons learned should induce a process to improve structures and resources for future similar events [ 10 , 11 ].…”

Section: A Multi-facetted Strain On Healthcare Providers and -Recipientsmentioning

confidence: 99%

See 2 more Smart Citations

Critical care during a pandemic —Are we prepared for the ethical dilemma?

Schnaubelt

Krammel²,

Sulzgruber³

2022

Journal of Critical Care

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Section: The Patients' Perspectivementioning

confidence: 99%

Section: The Patients' Perspectivementioning

confidence: 99%

Section: A Multi-facetted Strain On Healthcare Providers and -Recipientsmentioning

confidence: 99%

See 1 more Smart Citation

Critical care during a pandemic —Are we prepared for the ethical dilemma?

Schnaubelt

Krammel²,

Sulzgruber³

2022

Journal of Critical Care

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Allocation of intensive care resources during an infectious disease outbreak: a rapid review to inform practice

Fiest

Krewulak

Plotnikoff

et al. 2020

BMC Med

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Background The COVID-19 pandemic has placed sustained demand on health systems globally, and the capacity to provide critical care has been overwhelmed in some jurisdictions. It is unknown which triage criteria for allocation of resources perform best to inform health system decision-making. We sought to summarize and describe existing triage tools and ethical frameworks to aid healthcare decision-making during infectious disease outbreaks. Methods We conducted a rapid review of triage criteria and ethical frameworks for the allocation of critical care resources during epidemics and pandemics. We searched Medline, EMBASE, and SCOPUS from inception to November 3, 2020. Full-text screening and data abstraction were conducted independently and in duplicate by three reviewers. Articles were included if they were primary research, an adult critical care setting, and the framework described was related to an infectious disease outbreak. We summarized each triage tool and ethical guidelines or framework including their elements and operating characteristics using descriptive statistics. We assessed the quality of each article with applicable checklists tailored to each study design. Results From 11,539 unique citations, 697 full-text articles were reviewed and 83 articles were included. Fifty-nine described critical care triage protocols and 25 described ethical frameworks. Of these, four articles described both a protocol and ethical framework. Sixty articles described 52 unique triage criteria (29 algorithm-based, 23 point-based). Few algorithmic- or point-based triage protocols were good predictors of mortality with AUCs ranging from 0.51 (PMEWS) to 0.85 (admitting SOFA > 11). Most published triage protocols included the substantive values of duty to provide care, equity, stewardship and trust, and the procedural value of reason. Conclusions This review summarizes available triage protocols and ethical guidelines to provide decision-makers with data to help select and tailor triage tools. Given the uncertainty about how the COVID-19 pandemic will progress and any future pandemics, jurisdictions should prepare by selecting and adapting a triage tool that works best for their circumstances.

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Biomedical Ethics for Jehovah’s Witnesses and Patient Blood Management

Cho¹

2021

Soonchunhyang Med Sci

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Jehovah’s Witnesses refuse blood transfusions according to religious beliefs, and for this reason, most hospitals and doctors have refused their treatment. There are more than 100,000 religious people in Korea, but there are few bloodless centers that can receive their treatment. So, the number of Jehovah’s Witnesses patients visiting bloodless centers in Soonchunhyang University Bucheon Hospital has been increasing every year. Despite this situation, no legal or medical countermeasure has yet been proposed against them. Therefore, I would like to take a bioethical approach based on “principles of biomedical ethics” and introduce “patient blood management” which is currently spreading in advanced medical countries.

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Ethics Roundtable: Distribution of Critical Care Resources in the Setting of a COVID-19 Surge

Cited by 3 publications

References 1 publication

Critical care during a pandemic —Are we prepared for the ethical dilemma?

Critical care during a pandemic —Are we prepared for the ethical dilemma?

Allocation of intensive care resources during an infectious disease outbreak: a rapid review to inform practice

Biomedical Ethics for Jehovah’s Witnesses and Patient Blood Management

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