Reallocating ventilators during the coronavirus disease 2019 pandemic: Is it ethical?

Chu, Quyen D.; Correa, Ricardo; Henry, Tracey L.; McGregor, Kyle A.; Stoklosa, Hanni; Robinson, Loren; Jha, Sachin Sunny; Annamalai, Alagappan; Hsu, Benson; Gupta, Rohit; Patton, Desmond Upton; Moreno‐Walton, Lisa; Butts, Christine; Chai, Christy; Kuy, SreyRam

doi:10.1016/j.surg.2020.04.044

Cited by 16 publications

(22 citation statements)

References 14 publications

(16 reference statements)

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“…A utilitarian approach of reallocation in order to save many people collides with principles of autonomy, beneficence, and non‐maleficence with regard to the individual patient and may carry an emotional burden for health professionals. Chu et al argued that the act of reallocating a ventilator from one patient to another is morally inferior to passively palliate 22 . Similarly, clinicians may feel that the ethics of selecting one of two patients for the last ventilator differs from reallocating an in‐use ventilator to another patient and that withholding treatment differs from withdrawal of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Chu et al argued that the act of reallocating a ventilator from one patient to another is morally inferior to passively palliate. 22 Similarly, clinicians may feel that the ethics of selecting one of two patients for the last ventilator differs from reallocating an in‐use ventilator to another patient and that withholding treatment differs from withdrawal of treatment. On the contrary, Cameron et al outlined why withholding and withdrawing ventilation should not be differentiated.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Who gets the ventilator? A multicentre survey of intensivists' opinions of triage during the first wave of the COVID‐19 pandemic

Fjølner

Haaland

Jung

et al. 2022

Acta Anaesthesiol Scand

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Background: The COVID-19 pandemic has caused a shortage of intensive care resources. Intensivists' opinion of triage and ventilator allocation during the COVID-19 pandemic is not well described.Methods: This was a survey concerning patient numbers, bed capacity, triage guidelines, and three virtual cases involving ventilator allocations. Physicians from 400 ICUs in a research network were invited to participate. Preferences were assessed with a five-point Likert scale. Additionally, age, gender, work experience, geography, and religion were recorded.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Who gets the ventilator? A multicentre survey of intensivists' opinions of triage during the first wave of the COVID‐19 pandemic

Fjølner

Haaland

Jung

et al. 2022

Acta Anaesthesiol Scand

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show abstract

“…Further, the enhanced focus on public and collective good in RRI may create ethical quagmires that pit the individual disabled person against a generalized able-bodied public. Again drawing on recent developments in the COVID-19 pandemic, these intractable tensions rise to the fore, from the acceptable deaths of disabled people in the pursuit of herd immunity (Shanks 2020) to propositions that personal ventilators should be reallocated from chronically disabled people to the acutely ill, formerly able-bodied (Chu et al 2020). Disabled people are therefore both expected to utilize healthcare systems in order to approximate ablebodiedness and ablemindedness (and thus participate in social and political spheres) and to sacrifice themselves for the public good from which they are excluded.…”

Section: Exclusion Of Disabled Publicsmentioning

confidence: 99%

Forgotten publics: considering disabled perspectives in responsible research and innovation

Monteleone

2020

Journal of Responsible Innovation

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Responsible Research and Innovation (RRI) in healthcare requires a more substantial engagement with disability theory and disabled stakeholders to counteract histories of disenfranchisement in scientific and technological innovation. Historically, disability has been configured as undesirable pathology in medicine, often assuming successes in innovation can be measured by crossing the constructed threshold between disabled and able. Employing a disability-informed perspective in RRI for healthcare innovations means dismantling passive patient roles in favor of active and meaningful engagement, contextualizing participation in histories of exclusion from public life, and creating physical, infrastructural, and social spaces that value and encourage disabled perspectives. Ultimately, this piece argues that recognizing disability as a crucial epistemic resource can aid in the production of more transparent, inclusive, and meaningful research and innovation.

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“…The authors of this article, Chu et al 1 fail to establish that physicians must obey the laws of the land and refrain from creating laws and principles for individual patients. The authors have also bypassed the established writings on medicine during wartime when the principles of triage must be utilized.…”

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confidence: 99%

Thoughts from a senior surgeon with an interest in ethics

2020

Surgery

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The article by Chu et al 1 itself, I believe, is not helpful because it does what we in clinical ethics have attempted to avoid, and that is the conundrum of battling philosophies that are interesting to discuss, but of little help in a clinical situation. Remember, this was the impetus for Mark Siegler and Edmund Pellegrino 2 to create the specialty of clinical medical ethics in 1975, and then to use this approach in 1997 to address the Nazi doctors and Nuremberg. 3 Until that time, when clinicians confronted such challenges, they had to rely on clergy or philosophers from their adjacent universities, folks who had never confronted a patient in distress.I am especially troubled by the concept of doing good for society rather than for an individual patient. In Leo Alexander's pivotal article, "Medicine under a dictatorship" in the New England Journal of Medicine, 4 he explained that this was the plea to physicians from the Nazis. As he explains, only the Dutch physicians saw through this ruse and made the stand for their individual patients.

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Reallocating ventilators during the coronavirus disease 2019 pandemic: Is it ethical?

Cited by 16 publications

References 14 publications

Who gets the ventilator? A multicentre survey of intensivists' opinions of triage during the first wave of the COVID‐19 pandemic

Who gets the ventilator? A multicentre survey of intensivists' opinions of triage during the first wave of the COVID‐19 pandemic

Forgotten publics: considering disabled perspectives in responsible research and innovation

Thoughts from a senior surgeon with an interest in ethics

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