Chapter Four: Scarce Resource Allocation

Julian Savulescu, et al. (1 June 2020), “An ethical algorithm for rationing life sustaining treatment during the COVID-19 pandemic,” British Journal of Anaesthetics
Savulescu et al. provide an approach to allocation decisions that consists in a decision-making “tree,” which they believe is simple and effective in incorporating all essential ethical considerations.

Lynette Reid (16 June 2020), “Triage of critical care resources in COVID-19: a stronger role for justice,” Journal of Medical Ethics
Reid responds to Emanuel et al. (reading 4.1 in The Ethics of Pandemics). Reid takes issue with the claim that there is a consensus among ethicists that the primary principle for rationing should be the maximization of medical outcomes. Reid believes considerations of equity should play an important role, and she offers three ways to integrate equity concerns into triage protocols.

J. Bradley Segal (18 May 2020), “Why I Don’t Support Age-Related Rationing During the COVID Pandemic,” The Hastings Center Bioethics Forum [blog]
Segal responds directly to Miller (reading 4.5 in The Ethics of Pandemics). Segal argues that Miller’s main objective – saving the most lives – would be better met by not using age as a strict cut-off for ventilator allocation decisions. Instead, Segal claims, we should focus directly on who is most likely to survive.

Larry R. Churchill (13 April 2020), “On Being an Elder in a Pandemic,” The Hastings Centre Bioethics Forum [blog]
The readings in The Ethics of Pandemics focus on questions of what criteria should be used by those making rationing decisions. Churchill provides an alternative perspective by asking about the obligations of the public when resources are scarce. Churchill argues that elders have special obligations during a pandemic to use scarce resources parsimoniously.

Charlene Galarneau (20 April 2020), “Structural Racism, White Fragility, and Ventilator Rationing Policies,” The Hastings Center Bioethics Forum [blog]
Although most triage policies state that there should be no racial bias or discrimination, Galarneau notes that such policies will result in worse outcomes for people of color. Ostensibly neutral policies, such as allocating on the basis of underlying conditions, will disproportionately deny ventilators to members of those communities. In addition, Galarneau notes, inequitable exposure, testing, and treatment create a larger burden of infection in those communities.

Ari Ne’eman (10 April 2020), “When It Comes to Rationing, Disability Rights Law Prohibits More Than Prejudice,” The Hastings Center Bioethics Forum [blog]
Ne’eman argues that equity requires more than mere non-discrimination; it requires accommodation, even during a pandemic.

Alice Wong (4 April 2020), “I’m Disabled and Need a Ventilator to Live. Am I Expendable during This Pandemic?,” Vox.com
Many bioethicists and public health authorities have paid particular attention to the question of how a limited supply of ventilators ought to be allocated among patients suffering from COVID-19. However, as Wong notes, ventilators are also required to treat people who have other types of health conditions, and those people haven’t consistently been recognized in these allocation discussions. People with disabilities are prepared for the precariousness of pandemic life, but their voices have not been given enough weight in decision-making processes.