When Scarcity Meets Disparity: “Resources Allocation and COVID-19 Patients with Diabetes”

Abstract

The COVID-19 pandemic raised distinct challenges in the field of scarce resource allocation, a long-standing area of inquiry in the field of bioethics. Policymakers and states developed crisis guidelines for ventilator triage that incorporated such factors as immediate prognosis, long-term life expectancy, and current stage of life. Often these depend upon existing risk factors for severe illness, including diabetes. However, these algorithms generally failed to account for the underlying structural biases, including systematic racism and economic disparity, that rendered some patients more vulnerable to these conditions. This paper discusses this unique ethical challenge in resource allocation through the lens of care for patients with severe COVID-19 and diabetes.

Is there a right to a fully vaccinated care team?

“…29 These individuals also suffer a “double whammy” in which disparities generated by racism are then compounded by disparities due to vaccine hesitancy secondary to that racism. 30, 31 Allowing employment decisions, even incidental ones, based upon vaccine status—in the absence of universal mandates—then further exacerbates those inequities. These consequences for vaccine equity thus raise the subsequent question of whether healthcare institutions are responsible for improving/facilitating access and education about vaccines for patients and employees and what actions they may take to meet such responsibility, such as town halls, staff dedicated to vaccine education, free meals or paid sick days to take and/or recover from any side effects related to vaccination.…”

Taking care of the beloved patient

“…The issues of physician attitudes toward patients can prove of particular importance in the unjust or inequitable allocation of scarce resources. 23,24 While perceived social worth is no longer considered an acceptable justification for favorable rationing decisions, implicit biases can shape allocation in a range of fields from transplant to novel therapeutics. 25 A provider may see a "beloved" patient as more capable of stewarding an organ than he actually is, for instance, even (as may be the case with an empathy-inducing patient) if he does not have the necessary caregiver support.…”

The draw of the few: the challenge of crisis guidelines for extremely scarce resources

“…Some proposals urged giving precedence to healthcare workers,6 pregnant women7 and even political officials 8. Criticisms levelled against various CSCs included that they discriminate by age,9 10 race,11 12 disability13 and jurisdiction 14. Concerns have also been raised regarding their accuracy, with at least one major study suggesting that SOFA scores were less accurate than age alone in predicting survival with mechanical ventilation 15.…”