Procedural justice and egalitarian principles for rationing decisions in the COVID-19 crisis

Supady, Alexander; Bode, Christoph; Duerschmied, Daniel

doi:10.1186/s13054-020-03283-w

Cited by 3 publications

(6 citation statements)

References 5 publications

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“…Early works by Bartlett [ 3 ] and Lantos et al [ 10 ] describe how ECLS research is linked to its ethical prerequisites and consequences; Jaramillo et al [ 17 ] point out the rationality of deliberation in limiting ECLS; Carlisle et al [ 65 ] oppose the clear-cut understanding of futility; and in the face of the common utilitarian ECLS-prioritisation model advocated by Abrams et al [ 66 ], Supady et al [ 26 ] prefer the egalitarian approach of Norman Daniels, which is based on the right to participate in a fair and transparent allocation process. Finally, Ross [ 67 ] and Halpern et al [ 55 ] depict the notion of death as pragmatic and therefore alterable.…”

Section: Discussionmentioning

confidence: 99%

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Ethics in extracorporeal life support: a narrative review

et al. 2021

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During 50 years of extracorporeal life support (ECLS), this highly invasive technology has left a considerable imprint on modern medicine, and it still confronts researchers, clinicians and policymakers with multifarious ethical challenges. After half a century of academic discussion about the ethics of ECLS, it seems appropriate to review the state of the argument and the trends in it. Through a comprehensive literature search on PubMed, we identified three ethical discourses: (1) trials and evidence accompanying the use of ECLS, (2) ECLS allocation, decision-making and limiting care, and (3) death on ECLS and ECLS in organ donation. All included articles were carefully reviewed, arguments extracted and grouped into the three discourses. This article provides a narrative synthesis of these arguments, evaluates the opportunities for mediation and substantiates the necessity of a shared decision-making approach at the limits of medical care.

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Section: Discussionmentioning

confidence: 99%

“…The COVID-19 pandemic has further focused attention on prioritisation [ 25 , 26 ]. Rather than adding novel ethical conflicts, ECLS ultimately changed state from being relatively limited to absolutely scarce.…”

Section: Resource Allocation Decision-making and Limiting Care On Eclsmentioning

confidence: 99%

Ethics in extracorporeal life support: a narrative review

et al. 2021

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Section: Pre-covid-19 Approaches To Rationing Scarce Resourcesmentioning

confidence: 99%

“…Egalitarian principles alone cannot resolve the many controversies related to rationing decisions in a crisis, but procedural rules based on these principles might help guide decisions about how to distribute limited ICU beds, ventilators, or ECMO treatments, if the number of patients in need substantially outnumbers available treatments. 6 , 17 , 34 , 35 Applying principles promoting fair equality of opportunity might help policy makers, administrators, and clinicians guide medical teams when confronted with rationing decisions when operating under crisis standards of care (during times when standards of care must be substantially lowered in the setting of crisis), particularly for a complex, pervasive, and prolonged crisis, such as the COVID-19 pandemic. Such principles can be particularly relevant for allocating decisions when valid means of prognostication are lacking.…”

Section: A Covid-19 Informed Approach: Incorporating Egalitarian Prinmentioning

confidence: 99%

“…15 The triage committee structure alone does not prescribe the approach to decision making: the values and principles upon which the triage decisions are made must also be defined. 16,17 Many of these recommendations and guidelines introduce, as the main criterion for rationing, the probability that an individual patient will survive and benefit from ICU treatment. In effect, this amounts to an attempt to maximise the number of patient lives saved, an aim well established in emergency medicine triage models.…”

Section: Pre-covid-19 Approaches To Rationing Scarce Resourcesmentioning

confidence: 99%

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Allocating scarce intensive care resources during the COVID-19 pandemic: practical challenges to theoretical frameworks

Supady

Curtis

Abrams

et al. 2021

The Lancet Respiratory Medicine

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106

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The COVID-19 pandemic strained health-care systems throughout the world. For some, available medical resources could not meet the increased demand and rationing was ultimately required. Hospitals and governments often sought to establish triage committees to assist with allocation decisions. However, for institutions operating under crisis standards of care (during times when standards of care must be substantially lowered in the setting of crisis), relying on these committees for rationing decisions was impractical-circumstances were changing too rapidly, occurring in too many diverse locations within hospitals, and the available information for decision making was notably scarce. Furthermore, a utilitarian approach to decision making based on an analysis of outcomes is problematic due to uncertainty regarding outcomes of different therapeutic options. We propose that triage committees could be involved in providing policies and guidance for clinicians to help ensure equity in the application of rationing under crisis standards of care. An approach guided by egalitarian principles, integrated with utilitarian principles, can support physicians at the bedside when they must ration scarce resources.

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ECMO-Unterstützung während der ersten 2 Wellen der Coronapandemie – eine Umfrage an Zentren mit hohen Fallzahlen in Deutschland

Supady

Michels

Lepper

et al. 2022

Med Klin Intensivmed Notfmed

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Zusammenfassung Hintergrund Zu Beginn der Coronaviruspandemie wurde eine Überlastung der verfügbaren intensivmedizinischen Ressourcen befürchtet. Vielerorts wurden Routineeingriffe eingeschränkt und Kriterien für die Zuteilung knapper Ressourcen formuliert. In Deutschland kam es regional im Verlauf der Pandemie zeitweise zu Überlastungssituationen in den Kliniken. Speziell auf Intensivstationen zeigte sich eine Ressourcenknappheit, die zur Einschränkung von Leistungen und zu einer strengeren Indikationsstellung für ressourcenintensive Maßnahmen wie der extrakorporalen Membranoxygenierung (ECMO) geführt haben kann. Ziel dieser Arbeit ist es, einen Überblick über den Umgang mit diesen Belastungen an großen ECMO-Zentren in Deutschland zu gewinnen. Methodik Über persönliche Ansprache wurde im Frühjahr 2021 je ein Vertreter an großen ECMO-Zentren in Deutschland zur Teilnahme an einer Onlineumfrage eingeladen. Ergebnisse Insgesamt wurden 34 Einladungen verschickt, die Umfrage wurde von 23 Teilnehmern beantwortet. In allen Zentren wurden im Verlauf der Pandemie Routineeingriffe verschoben. Die Hälfte der Zentren erhöhte die Anzahl von Betten, auf denen ECMO-Verfahren durchgeführt werden konnten, in einem Drittel der Zentren wurde dennoch der Beginn mindestens einer ECMO-Unterstützung wegen einer befürchteten Ressourcenknappheit verzögert. In 17 % der Zentren wurde mindestens einem Patienten eine ECMO verweigert, die der Patient unter den Bedingungen vor der Pandemie aller Voraussicht nach erhalten hätte. Diskussion Die Ergebnisse dieser Onlineumfrage zeigen, dass die erlebten Belastungen und Ressourcenengpässe in einigen Zentren zu einer zurückhaltenden ECMO-Indikationsstellung führten.

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Procedural justice and egalitarian principles for rationing decisions in the COVID-19 crisis

Cited by 3 publications

References 5 publications

Ethics in extracorporeal life support: a narrative review

Ethics in extracorporeal life support: a narrative review

Allocating scarce intensive care resources during the COVID-19 pandemic: practical challenges to theoretical frameworks

ECMO-Unterstützung während der ersten 2 Wellen der Coronapandemie – eine Umfrage an Zentren mit hohen Fallzahlen in Deutschland

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