PT  - JOURNAL ARTICLE
AU  - Alexander T M Cheung
AU  - Brendan Parent
TI  - Mistrust and inconsistency during COVID-19: considerations for resource allocation guidelines that prioritise healthcare workers
AID  - 10.1136/medethics-2020-106801
DP  - 2021 Feb 01
TA  - Journal of Medical Ethics
PG  - 73--77
VI  - 47
IP  - 2
4099  - http://jme.bmj.com/content/47/2/73.short
4100  - http://jme.bmj.com/content/47/2/73.full
SO  - J Med Ethics2021 Feb 01; 47
AB  - 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.