Article Text
Abstract
Policies promoted and adopted for allocating ventilators during the COVID-19 pandemic have often prioritised healthcare workers or other essential workers. While the need for such policies has so far been largely averted, renewed stress on health systems from continuing surges, as well as the experience of allocating another scarce resource—vaccination—counsel revisiting the justifications for such prioritisation. Prioritising healthcare workers may have intuitive appeal, but the ethical justifications for doing so and the potential harms that could follow require careful analysis. Ethical justifications commonly offered for healthcare worker prioritisation for ventilators rest on two social value criteria: (1) instrumental value, also known as the ‘multiplier effect’, which may preserve the ability of healthcare workers to help others, and (2) reciprocity, which rewards past usefulness or sacrifice. We argue that these justifications are insufficient to over-ride the common moral commitment to value each person’s life equally. Institutional policies prioritising healthcare workers over other patients also violate other ethical norms of the healthcare professions, including the commitment to put patients first. Furthermore, policy decisions to prioritise healthcare workers for ventilators could engender or deepen existing distrust of the clinicians, hospitals and health systems where those policies exist, even if they are never invoked.
- COVID-19
- allocation of health care resources
- distributive justice
- interests of health personnel/institutions
- public health ethics
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
- Should healthcare workers be prioritised during the COVID-19 pandemic? A view from Madrid and New York
- Ethical allocation of future COVID-19 vaccines
- Mistrust and inconsistency during COVID-19: considerations for resource allocation guidelines that prioritise healthcare workers
- Justice in COVID-19 vaccine prioritisation: rethinking the approach
- Challenges facing essential workers: a cross-sectional survey of the subjective mental health and well-being of New Zealand healthcare and ‘other’ essential workers during the COVID-19 lockdown
- Race and resource allocation: an online survey of US and UK adults’ attitudes toward COVID-19 ventilator and vaccine distribution
- Identifying ethical values for guiding triage decisions during the COVID-19 pandemic: an Italian ethical committee perspective using Delphi methodology
- Vaccine ethics: an ethical framework for global distribution of COVID-19 vaccines
- Triage and justice in an unjust pandemic: ethical allocation of scarce medical resources in the setting of racial and socioeconomic disparities
- Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants