Who will receive the last ventilator: why COVID-19 policies should not prioritise healthcare workers

Abstract

Policies promoted and adopted for allocating ventilators during the COVID-19 pandemic have often prioritised healthcare workers or other essential workers. While the need for such policies has so far been largely averted, renewed stress on health systems from continuing surges, as well as the experience of allocating another scarce resource—vaccination—counsel revisiting the justifications for such prioritisation. Prioritising healthcare workers may have intuitive appeal, but the ethical justifications for doing so and the potential harms that could follow require careful analysis. Ethical justifications commonly offered for healthcare worker prioritisation for ventilators rest on two social value criteria: (1) instrumental value, also known as the ‘multiplier effect’, which may preserve the ability of healthcare workers to help others, and (2) reciprocity, which rewards past usefulness or sacrifice. We argue that these justifications are insufficient to over-ride the common moral commitment to value each person’s life equally. Institutional policies prioritising healthcare workers over other patients also violate other ethical norms of the healthcare professions, including the commitment to put patients first. Furthermore, policy decisions to prioritise healthcare workers for ventilators could engender or deepen existing distrust of the clinicians, hospitals and health systems where those policies exist, even if they are never invoked.

COVID-19 vaccination status should not be used in triage tie-breaking

“…Later, White and Lo revised this scheme to balance population health outcomes and equity during first-order triaging. Controversially, they added a patient’s status as an ‘essential worker’ and their Area of Deprivation Index (ADI)—a ranking of their neighbourhood-based socioeconomic disadvantage to their first-order criteria 9 10. And while White and Lo continue to use age as a second-order tie-breaker, they recommend random selection if a tie remains after other factors.…”

The Ethical Principles in Ethical Guidance Documents during the COVID-19 Pandemic in the United Kingdom and the Republic of Ireland: A Qualitative Systematic Review

“…9 For example, the surge in numbers of patients needing ventilation and a limited number of machines meant that doctors needed to decide who should be prioritized and given lifesaving treatment. 10 Government departments and professional bodies such as medical councils across the United Kingdom (UK) and Ireland issued guidance, policies, and frameworks which presented advice and detailed instructions about important ethical considerations for decision making during the pandemic. For example, the Scottish Government published ethical guidance which discussed issues such as ethical allocation of scarce resources 11 and the British Psychological Society (London, UK) issued guidance on conducting research with human participants during the COVID-19 pandemic.…”