Leaving No Ethical Value Behind: Triage Protocol Design for Pandemic Rationing

Abstract

We are grateful for input from several medical professionals. Nikhil Agarwal, Alex Rees-Jones, Robert Truog, Iván Werning, and Doug White provided helpful comments. Feedback from Eric Budish, David Delacrétaz, and Govind Persad was particularly valuable. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research. NBER working papers are circulated for discussion and comment purposes. They have not been peerreviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.

Rationing, racism and justice: advancing the debate around ‘colourblind’ COVID-19 ventilator allocation

“…So-called reserve systems have been used to ensure that ‘colourblind’ assessments (focusing exclusively on ‘objective’ entry examination results) no longer disproportionately privilege the better-off, but also provide allocations for worse-off populations, with recent adaptations for ventilator rationing. 47 Equity weights can instantly eliminate John’s unfair advantage, and James’ and Martin’s unfair disadvantage. While practically straightforward, the strongest challenge is a legal one.…”

Laypersons’ Priority-Setting Preferences for Allocating a COVID-19 Patient to a Ventilator: Does a Diagnosis of Alzheimer’s Disease Matter?

“…5 Specifically, due to the threat of their shortage and their potential lifesaving nature, the decision to allocate or reallocate ventilators is accompanied by serious medical and ethical dilemmas. [5][6][7][8] In order to attain a fair allocation of scarce resources while responding rapidly and effectively to the crisis, guidelines and protocols have been developed in many countries. A recent review of 27 relevant guidelines published in different states in the US showed that the majority of them do not give priority to any specific group for the allocation of ventilators.…”

Prioritising surgical cases deferred by the COVID-19 pandemic: an ethics-inspired algorithmic framework for health leaders

“…4 However, one limitation of the point system is that it does not optimise for multiple competing values and applies the same fixed criteria for all subgroups, some of which may not benefit from it. 5 For example, sicker patients may never receive ventilators under a point system, as they are 'too sick' and thus could never get good enough scores to qualify.…”

“…An alternative decision method used in allocating scarce care resources is the reserve system, whereby allocations are established for protected classes. 5 For example, a certain number of surgical cases per week may be reserved for particular groups, such as Good Samaritans, essential personnel and disabled individuals. Yet, the allocation decisions in the reserve system present their own set of ethical and implementation challenges.…”