Ethical Guidance for Hard Decisions: A Critical Review of Early International COVID-19 ICU Triage Guidelines.

This article provides a critical comparative analysis of the substantive and procedural values and ethical concepts articulated in guidelines for allocating scarce resources in the COVID-19 pandemic. We identified 21 local and national guidelines written in English, Spanish, German and French; applicable to specific and identifiable jurisdictions; and providing guidance to clinicians for decision making when allocating critical care resources during the COVID-19 pandemic. US guidelines were not included, as these had recently been reviewed elsewhere. Information was extracted from each guideline on: 1) the development process; 2) the presence and nature of ethical, medical and social criteria for allocating critical care resources; and 3) the membership of and decision-making procedure of any triage committees. Results of our analysis show the majority appealed primarily to consequentialist reasoning in making allocation decisions, tempered by a largely pluralistic approach to other substantive and procedural values and ethical concepts. Medical and social criteria included medical need, co-morbidities, prognosis, age, disability and other factors, with a focus on seemingly objective medical criteria. There was little or no guidance on how to reconcile competing criteria, and little attention to internal contradictions within individual guidelines. Our analysis reveals the challenges in developing sound ethical guidance for allocating scarce medical resources, highlighting problems in operationalising ethical concepts and principles, divergence between guidelines, unresolved contradictions within the same guideline, and use of naïve objectivism in employing widely used medical criteria for allocating ICU resources.

A biographer and a bioethicist take on the CRISPR revolution

The book winds through her early life and career in biochemistry, her work in developing CRISPR, the fight over which lab discovered what and when, who would be awarded patents on CRISPR technology, its use in developing diagnostics for the COVID virus SARS-CoV-2 and, finally, the award of the 2020 Nobel Prize in Chemistry to Doudna and her colleague Emanuelle Charpentier. Reading this straight after Creely's soul-searching about what went wrong in the case of He Jiankui, it's impossible not to conclude that the blame lies less with overweening individual ambition as with an international scientific culture that, as Isaacson says, rewards "provocative research, celebrity, national scientific competitiveness, and firsts". Jackie Leach Scully is a bioethicist at the University of New South Wales, Sydney, Australia. e-mail: jackie.leach.scully@unsw.edu.au CRISPR People: The Science and Ethics of Editing Humans Henry T. Greely MIT Press (2021) The Code Breaker: Jennifer Doudna, Gene Editing, and the Future of the Human Race Walter Isaacson Simon & Schuster (2021)

Disability, Disablism, and COVID-19 Pandemic Triage.

Pandemics such as COVID-19 place everyone at risk, but certain kinds of risk are differentially severe for groups already made vulnerable by pre-existing forms of social injustice and discrimination. For people with disability, persisting and ubiquitous disablism is played out in a variety of ways in clinical and public health contexts. This paper examines the impact of disablism on pandemic triage guidance for allocation of critical care. It identifies three underlying disablist assumptions about disability and health status, quality of life, and social utility, that unjustly and potentially catastrophically disadvantage people with disability in COVID-19 and other global health emergencies.

Disability Rights as a Necessary Framework for Crisis Standards of Care and the Future of Health Care.

In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) "Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations," which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment to both distributive and recognitive justice. The disability rights movement's demand "Nothing about us, without us" requires substantive inclusion of disabled people in decision-making related to their interests, including in crisis planning before, during, and after a pandemic like Covid-19.