The Ethics of Creating a Resource Allocation Strategy During the COVID-19 Pandemic
Open Access
- 1 July 2020
- journal article
- research article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 146 (1)
- https://doi.org/10.1542/peds.2020-1243
Abstract
The coronavirus disease 2019 pandemic has affected nearly every aspect of medicine and raises numerous moral dilemmas for clinicians. Foremost of these quandaries is how to delineate and implement crisis standards of care and, specifically, how to consider how health care resources should be distributed in times of shortage. We review basic principles of disaster planning and resource stewardship with ethical relevance for this and future public health crises, explore the role of illness severity scoring systems and their limitations and potential contribution to health disparities, and consider the role for exceptionally resource-intensive interventions. We also review the philosophical and practical underpinnings of crisis standards of care and describe historical approaches to scarce resource allocation to offer analysis and guidance for pediatric clinicians. Particular attention is given to the impact on children of this endeavor. Although few children have required hospitalization for symptomatic infection, children nonetheless have the potential to be profoundly affected by the strain on the health care system imposed by the pandemic and should be considered prospectively in resource allocation frameworks.This publication has 38 references indexed in Scilit:
- TriageSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2014
- ICU severity of illness scoresCurrent Opinion in Critical Care, 2014
- Fair InningsBioethics, 2014
- PELOD-2Critical Care Medicine, 2013
- Methods of Mortality Risk Adjustment in the NICU: A 20-Year ReviewPEDIATRICS, 2013
- Principles for allocation of scarce medical interventionsThe Lancet, 2009
- Clinical review: Allocating ventilators during large-scale disasters – problems, planning, and processCritical Care, 2007
- Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre studyThe Lancet, 2003
- A study on the ethics of microallocation of scarce resources in health careJournal of Medical Ethics, 2002
- The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failureIntensive Care Medicine, 1996