Article Text
Abstract
Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. With rising cases in many countries, and likely further peaks in the coming colder seasons, ventilator triage guidance remains a central part of the COVID-19 policy response. The dominant model in ventilator triage guidelines prioritises the ethical principles of saving the most lives and saving the most life-years. We sought to ascertain to what extent this focus aligns, or conflicts, with the preferences of disadvantaged minority populations. We conducted a bibliographical search of PubMed and Google Scholar and reviewed all ventilator rationing guidelines included in major recent systematic reviews, yielding 589 studies before screening. Post screening, we found six studies comprising a total of 10 591 participants, with 1247 from disadvantaged populations. Three studies reported findings stratified by race and age, two of which stratified by income. Studies included two to seven principles; all included ‘save the most lives’. Involvement of disadvantaged minority populations in eliciting preferences is very limited; few studies capture race and income. This is concerning, as despite relatively small numbers and framing effects there is an observable and plausible trend suggesting that disadvantaged groups worry that dominant principles reduce their chances of receiving a ventilator. To avoid compounding prior historical and structural disadvantage, policy makers need to engage more fully with these populations in designing and justifying ventilator rationing guidance and review their adequacy. Likewise, clinicians need to be aware that their implementation of dominant triage guidelines is viewed with higher levels of concern by minority populations.
- allocation of health care resources
- distributive justice
- ethics
- resource allocation
- COVID-19
This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
https://bmj.com/coronavirus/usageStatistics from Altmetric.com
Read the full text or download the PDF:
Other content recommended for you
- Rationing, racism and justice: advancing the debate around ‘colourblind’ COVID-19 ventilator allocation
- Racial differences in measures of glycemia in the Vitamin D and Type 2 Diabetes (D2d) Study: a secondary analysis of a randomized trial
- Do quality improvement initiatives for diabetes care address social inequities? Secondary analysis of a systematic review
- Understanding how self-management interventions work for disadvantaged populations living with chronic conditions: protocol for a realist synthesis
- Covid-19: how to prioritize worse-off populations in allocating safe and effective vaccines
- Pandemic prioritarianism
- Public attitudes about equitable COVID-19 vaccine allocation: a randomised experiment of race-based versus novel place-based frames
- Evidence based medicine and justice: a framework for looking at the impact of EBM upon vulnerable or disadvantaged groups
- The impact of the economic crisis on unmet dental care needs in Spain
- Neighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study