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Am J Bioeth ; 20(7): 15-27, 2020 07.
Article in English | MEDLINE | ID: covidwho-828574


The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing policies for pandemics differ by institution, health system, and applicable law. Most seem to agree that a patient's ability to benefit from treatment and to survive are first-order considerations. However, there is debate about what clinical measures should be used to make that determination and about other factors that might be ethically appropriate to consider. In this paper, we discuss resource allocation and several related ethical challenges to the healthcare system and society, including how to define benefit, how to handle informed consent, the special needs of pediatric patients, how to engage communities in these difficult decisions, and how to mitigate concerns of discrimination and the effects of structural inequities.

Advisory Committees , Betacoronavirus , Coronavirus Infections/epidemiology , Health Care Rationing/ethics , Pneumonia, Viral/epidemiology , Bioethics , COVID-19 , Coronavirus Infections/prevention & control , Humans , Pandemics/ethics , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , SARS-CoV-2 , United States/epidemiology
Am J Hosp Palliat Care ; 38(5): 428-431, 2021 May.
Article in English | MEDLINE | ID: covidwho-740339


The majority of states require the signature of a surrogate decision maker on a POLST form for a patient who lacks decisional capacity. While commendable in its intention to ensure informed consent, in some cases this may lead the surrogate to feel that they are signing their loved one's "death warrant," adding to their emotional and spiritual distress. In this paper we argue that such a signature should be recommended rather than required, as it is neither a sufficient nor necessary condition of informed consent. Additional steps-such as requiring the attestation and documentation of the signing health care professional that verbal consent was fully informed and voluntary-can achieve the ultimate goal of respecting patient autonomy without adding to the surrogate's burden.

Decision Making , Empathy , Humans , Informed Consent
Pediatrics ; 146(1)2020 07.
Article in English | MEDLINE | ID: covidwho-203500


The coronavirus disease 2019 pandemic has affected nearly every aspect of medicine and raises numerous moral dilemmas for clinicians. Foremost of these quandaries is how to delineate and implement crisis standards of care and, specifically, how to consider how health care resources should be distributed in times of shortage. We review basic principles of disaster planning and resource stewardship with ethical relevance for this and future public health crises, explore the role of illness severity scoring systems and their limitations and potential contribution to health disparities, and consider the role for exceptionally resource-intensive interventions. We also review the philosophical and practical underpinnings of crisis standards of care and describe historical approaches to scarce resource allocation to offer analysis and guidance for pediatric clinicians. Particular attention is given to the impact on children of this endeavor. Although few children have required hospitalization for symptomatic infection, children nonetheless have the potential to be profoundly affected by the strain on the health care system imposed by the pandemic and should be considered prospectively in resource allocation frameworks.

Betacoronavirus , Pandemics/ethics , Pediatrics/ethics , Resource Allocation/ethics , COVID-19 , Child , Coronavirus Infections/therapy , Delivery of Health Care/ethics , Delivery of Health Care/methods , Humans , Pediatrics/methods , Pneumonia, Viral/therapy , Resource Allocation/methods , SARS-CoV-2