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Mistrust and inconsistency during COVID-19: considerations for resource allocation guidelines that prioritise healthcare workers
  1. Alexander T M Cheung,
  2. Brendan Parent
  1. Division of Medical Ethics, New York University School of Medicine, New York, New York, USA
  1. Correspondence to Alexander T M Cheung, Division of Medical Ethics, New York University School of Medicine, New York, New York, USA; alexander.cheung{at}


As the USA contends with another surge in COVID-19 cases, hospitals may soon need to answer the unresolved question of who lives and dies when ventilator demand exceeds supply. Although most triage policies in the USA have seemingly converged on the use of clinical need and benefit as primary criteria for prioritisation, significant differences exist between institutions in how to assign priority to patients with identical medical prognoses: the so-called ‘tie-breaker’ situations. In particular, one’s status as a frontline healthcare worker (HCW) has been a proposed criterion for prioritisation in the event of a tie. This article outlines two major grounds for reconsidering HCW prioritisation. The first recognises trust as an indispensable element of clinical care and mistrust as a hindrance to any public health strategy against the virus, thus raising concerns about the outward appearance of favouritism. The second considers the ways in which proponents of HCW prioritisation deviate from the very ‘ethics frameworks’ that often preface triage policies and serve to guide resource allocation—a rhetorical strategy that may undermine the very ethical foundations on which triage policies stand. By appealing to trust and consistency, we re-examine existing arguments in favour of HCW prioritisation and provide a more tenable justification for adjudicating on tie-breaker events during crisis standards of care.

  • resource allocation
  • allocation of health care resources
  • public health ethics
  • policy guidelines/inst. review boards/review cttes

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  • Contributors AC developed the concept for the article with consultation and expansion from BP. AC performed the literature review and primary drafting, while BP provided revisions and expansion on concepts. AC is the guarantor for the overall content.

  • Funding AC and BP acknowledge support from the NYU Rudin Medical Ethics and Humanities Fellowship (No Grant/Award Number).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work.

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