The challenge posed by the COVID-19 pandemic: how to decide who deserves life-saving medical devices?

Abstract

PurposeThe current COVID-19 pandemic stressed the importance of discussing the problems surrounding the scarcity of healthcare resources. Healthcare rationing has been a constant issue, but in the present pandemic, the need to choose who to treat and who to let die became a pressing reality. What criteria to adopt or what protocol to follow is a difficult challenge politicians face because it involves moral judgments and/or ethical values. As there are multiple ethically permissible criteria to allocate life-saving medical resources and we will all bear the consequences of these rationing decisions, it is important to explore the appropriateness of each of these approaches. Here, the author describes the main rationing criteria proposed in the literature and explores their applicability to an absolute scarcity of resources as the current one. Finally, the author describes the ongoing COVID-19 pandemic in Portugal and proposes some guidelines to ensure a fair allocation of resources.Design/methodology/approachA literature review was made regarding some rationing protocols, and a qualitative research was followed to collect data regarding the number of daily infected and daily deaths by COVID-19.FindingsPortugal has not, fortunately and so far, been as badly hit by COVID-19 as other European Countries. However a rigorous and explicit protocol is lacking to help health professionals at the frontline to take legitimate rationing decisions.Practical implicationsThe author contributes for the discussion about life-or-death decisions by proposing some clinical practice lines that may be applied fairly and consistently.Originality/valueThis study is the first attempt to emphasize the need to set life-or-death guidelines in Portugal in a public health emergency and to propose some of these guidelines.

Health governance: reponses to and effects of COVID-19

“…This became a global problem at the start of COVID-19 as the pandemic exposed how underresourced many health services were in terms of both personnel and essential equipment (TolchinHull and Kraschel, 2020). Because of the global nature of the crisis, many essential pieces of equipment such as PPE and ventilators became subject to speculation causing quickly rising prices; this only served to exacerbate the problem particularly in LMIC without the resources to outbid richer health care systems (Pinho, 2021). Lack of equipment also led to confusion in public health advice with the WHO originally advising against face coverings for the public and then as more non-medical masks became available, recommending that everyone wear masks in public settings.…”

“…A dearth of equipment exposed the existing problem of health care rationing and triage. In Portugal, this problem quickly became acute because of the already low level of equipment in a health service, which is under-funded compared to many of Portugal's European neighbours (Pinho, 2021). In order to take the ethical and practical burden of decision-making away from individual doctors, it became apparent that a structured pandemic treatment protocol would be necessary.…”

“…These inequalities are exacerbated during a pandemic as the total death rate from all causes is higher. Pinho (2021) points out that in times of scarcity health care rationing, which often happens with implicit understanding of unwritten rules, must become explicit and transparent. People have a moral right to understand why decisions are made about who is admitted to hospital and how resources such as ventilators are allocated.…”

Public preferences for allocating absolute scarce critical healthcare resources during the COVID-19 pandemic

“…Moral guidance for how to fairly allocate scarce medical resources in context of absolute scarcity (e.g. pandemics, natural disaster such as hurricanes, biological warfare scenarios) have been proposed by ethicists and a number of allocation principles have been defined and balanced against each other (Emanuel and Wertheimer, 2006;Persad et al, 2009;White et al, 2009;Beauchamp and Childress, 2012;Emanuel et al, 2020;Pinho, 2020): (1) maximizing individual benefits; (2) treating people equally; (3) maximizing social benefits -instrumental value; (4) priority to sickest and (5) lifecycle principle. Which of these criteria to use and which protocol to follow are questions that remain unanswered.…”

Evaluating Health System Efficiency using Data Envelopment Analysis: A case of Indian Healthcare System

“…With the raging COVID19 situation, many health systems have come under stress and raises more questions than answers about the efficiency of our health systems (Pinho, 2020). Healthcare is complex system of systems that interact in highly intricate and variable ways with multiple stakeholders and is faced with increasing demand and reduced resources (Bhattacharjee and Ray, 2014;Faezipour and Ferreira, 2011;Myllärniemi and Helander, 2012;Schiavone et al, 2020).…”