Giving Compass' Take:
- Thomas W. Concannon and Lori Frank outline a document designed to provide clear and consistent ethical guidance to healthcare providers on the allocation of medical resources as hospital and ICU beds fill up with COVID-19 patients.
- What are the benefits to standardizing resource allocation decision-making in hospitals as America's hospitals exceed their capacities? How can funders help to alleviate strain on medical workers and support equitable and fair access to healthcare?
- Read about what transitioning to a post-pandemic world might look like.
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The surge-upon-surge of COVID-19 cases in the United States has again focused attention on scarcity of lifesaving medical resources—hospital beds, ICU equipment, ventilators, oxygen, medications, and hospital staff. With nearly 124,000 people hospitalized—and more than 23,000 in ICU care—hospitals have reached and exceeded their capacity from California to Georgia to Texas to Tennessee.
What happens next in each of those states will differ. Guidelines for how to allocate health care resources—where they exist at all—vary widely by state. Fundamental questions about who gets treated and who does not are addressed in vastly different ways sometimes from one hospital to the next. Some rely on a “first come first served” system. Others use “lottery” approaches. Some prioritize younger patients over older ones. Some, but not all, prioritize treatment for health care workers. In places without clear protocols, clinical staff become de facto allocators of lifesaving care, leading to moral distress.
To improve decisionmaking, increase transparency, and reduce potentially harmful variation in guidelines from one facility to the next, we developed a Core Guidance Checklist. It is based on input from a panel of clinicians, health system leaders, patients and consumers, disability advocates, policymakers, legal scholars, bioethicists, and clinical researchers.
As COVID-19 cases and hospitalizations surge to new highs in early 2021, states, health systems, and the public continue to need clarity on health care resource allocation policy. The Core Guidance Checklist provides clear and consistent criteria for structuring such decisions, particularly when resources are scarce and when clinical and ethical principles must be reconciled. By involving affected communities beyond clinicians and health systems, RAND's checklist offers a remedy for troubling variation in access to life-saving care during the pandemic and can improve public trust in decisions.
Read the full article about deciding who gets care by Thomas W. Concannon and Lori Frank at RAND Corporation.