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3.
J Clin Ethics ; 31(4): 303-317, 2020.
Article in English | MEDLINE | ID: covidwho-812923

ABSTRACT

The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the triage protocol, summarize the protocol itself, and discuss the major ethical challenges encountered, along with our answers to these challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments. We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges that they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the COVID-19 pandemic and similar public health emergencies.


Subject(s)
Health Care Rationing/ethics , Health Resources/supply & distribution , Pandemics/ethics , Triage/ethics , Betacoronavirus , COVID-19 , Child , Coronavirus Infections , Emergencies , Female , Humans , Pneumonia, Viral , Pregnancy , Public Health , SARS-CoV-2
6.
Pediatrics ; 146(1)2020 07.
Article in English | MEDLINE | ID: covidwho-203500

ABSTRACT

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.


Subject(s)
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
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