The Toughest Triage: When medical resources are limited, who
Get authentic, real-time news that helps you fight COVID-19 better.
Install PlexusMD App for doctors. It's free.
Long before the new coronavirus, ethicists have contemplated the moral dilemma of who is first in line when medical resources are strained, creating frameworks for apportioning treatment so that doctors and hospitals could avoid making fraught decisions on the fly.

Here is a brief from a paper released in the New England Journal of Medicine (March '20) outlining three ethical values to guide decision-making when rationing care.

Approaches to rationing care

1. Sickest first: A prioritarian approach

In emergency care, for example, a patient suffering from a heart attack would be seen before a patient with a broken arm.

This approach assumes that resource constraints are temporary and that additional resources will soon become available to treat other patients. But during a period of prolonged scarcity, such as the current COVID-19 pandemic, this approach fails to consider the trade-off between treating one critically ill patient for a long period of time versus quickly treating several patients who are not as sick.

2. An equal chance: An egalitarian approach

In this system, patients would be chosen at random in a lottery.

This practice requires no information about the patient, eliminates personal influence on the process. As a result, patients get an equal chance to access treatment but not necessarily an equal allocation of resources. A very sick patient selected first could use up a lot of resources, for example, creating an even greater scarcity for patients selected later.

3. Maximizing benefits of treatment: A utilitarian approach

One example could be to aim for the longest life-years. A younger person with more years to live would be prioritized over an older person.

Patients with less severe symptoms would be prioritized because they seem more likely to recover. Saving the most lives serves as the guiding principle to rationing care, though this approach raises questions about what criteria are used to determine priority or exclusion.

Factors that could influence decisions about prioritizing care

1. The multiplier effect: Prioritize healthcare workers who may be able to return to work after the treatment.

2. Social worth: Prioritize care for government leaders, professionals, heads of families, or caregivers.

3. Life cycle: Prioritize those in the early stages of life.

D●●●●●a D D and 18 others like this13 shares
Dr. N●●●●a G●●●a
Dr. N●●●●a G●●●a Obstetrics and Gynaecology
Its difficult unless the family collectively and rationally helps in taking a decision. It was done in the past, doctors have always been people who avoid putting their very old relatives on ventilators for long.
May 14, 2020Like2