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Promoting equity with a multi-principle framework to allocate scarce ICU resources
  1. Douglas White1,
  2. Bernard Lo2
  1. 1Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  2. 2Department of Medicine, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Professor Douglas White, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; douglas.white{at}pitt.edu

Abstract

We wholeheartedly agree with Schmidt and colleagues’ efforts to promote equity in intensive care unit (ICU) triage. We also take issue with their characterisation of the New Jersey (NJ) allocation framework for ICU beds and ventilators, which is modelled after the multi-principle allocation framework we developed early in the pandemic. They characterise it as a two-criterion allocation framework and claim—without evidence—that it will ‘compound disadvantage for black patients’. However, the NJ triage framework—like the model allocation policy we developed—actually contains four allocation criteria: the two criteria that the authors mentioned (chances for survival and near-term prognosis) and two criteria that they failed to mention which we included to promote equity: giving priority to frontline essential workers and giving priority to younger patients. These omissions are problematic both for reasons of factual accuracy and because the two criteria they failed to acknowledge would likely mitigate rather than exacerbate racial disparities during triage.

  • allocation of health care resources
  • distributive justice
  • public health ethics

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Footnotes

  • Contributors DW conceived of and drafted the manuscript. BL provided important intellectual input and provided edits to the manuscript.

  • Funding This study was funded by Center for Information Technology (Grant number: K24 HL148314).

  • Competing interests DW reports grants from NIH-NHLBI K24 HL148314, during the conduct of the study; personal fees from American Thoracic Society for work as an Associate Editor of the AJRCCM, personal fees from UpToDate for work as a contributing author, outside the submitted work.

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

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