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COVID-19 Vaccine Refusal and Fair Allocation of Scarce Medical Resources provides a framework for consideration of some past patient decisions—including forgoing vaccination—in allocation of scarce healthcare treatments, April 2022 |
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Fair access to scarce medical capacity for non-covid-19 patients: a role for reserves focuses on the problem of non-COVID patients facing delayed care during COVID surges, February 2022 |
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In Life-Years & Rationing in the COVID-19 Pandemic: A Critical Analysis, MaryKatherine Gaurke and colleagues argue against preservation of life-years as a strategy for rationing scarce resources, September 2021 |
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Alex Rajczi and colleagues describe the University of California Critical Care Bioethics Working Group’s recommendations for developing triage protocols and contrast their recommendations with those of the “Pittsburgh framework,” September 2021 |
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Should Covid Vaccination Status be Used to Make Triage Decisions? addresses the use of vaccination status as a first-order and second-order triage consideration in allocating scarce resources to COVID patients, August 2021 |
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Ethical Allocation of Remdesivir argues for distributing remdesivir to communities according to their death and ventilator usage rates to maximize benefit and equity, July 2020 |
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In Mitigating Inequities and Saving Lives with ICU Triage During the COVID-19 Pandemic, Doug White, UPMC Endowed Chair for Ethics in Critical Care Medicine and UCSF’s Bernie Lo, address the concern that “use of existing ICU triage protocols to allocate scarce ventilators and critical care resources—most of which are designed to save as many lives as possible—would compound” the inequitable burdens of COVID-19 that have disproportionately fallen on already disadvantaged groups, American Journal of Respiratory and Critical Care Medicine, December 2, 2020 |
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Access to Therapeutic and Palliative Drugs in the Context of Covid-19: Justice and the Relief of Suffering from The Hastings Center, July 14, 2020 |
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Volume 20, Issue 7 of The American Journal of Bioethics, is a special issue on COVID-19 and allocation of scarce resources, with articles by Center faculty members Lisa Parker, Doug White, and Mark Wicclair, July 8, 2020, contact bioethics@pitt.edu regarding AJOB’s limited article access |
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Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force, June 8, 2020, contact bioethics@pitt.edu regarding AJOB’s limited article access |
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Contingency and Crisis Standards of Care – Palliative Care and Hospice Services, issued by Colorado’s Governor’s Expert Emergency Epidemic Response Committee, was updated to take into consideration the challenges presented by COVID-19, and join the Colorado Crisis Standards of Care documents the Committee approved on April 5, 2020 |
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Ethical Allocation Framework for Emerging Treatments of COVID-19, from the Commonwealth of Pennsylvania, articulates an allocation framework embracing the public health goal of redressing inequities that make health and safety less accessible to disadvantaged groups and, within this broader framework, provides an example of how somewhat increased chances to receive treatment for COVID-19 may be given to members of disadvantaged communities |
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Model Hospital Policy for Fair Allocation of Scarce Medications to Treat COVID-19 from contributing authors at the University of Pittsburgh/UPMC Health System, Boston College, MIT, University of Denver, and Harvard University, May 28, 2020 draft A Conversation about Allocating Scarce COVID-19 Medications: The Case for Increasing Disadvantaged Groups’ Access, with University of Pittsburgh Professor of Medicine Mark Schmidhofer, part of the Pandemic Policies & Practices series co-sponsored by the Mid-Atlantic Regional Public Health Training Center and the Center for Bioethics & Health Law, July 7, 2020 |
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A Proposed Lottery System to Allocate Scarce COVID-19 Medications: Promoting Fairness and Generating Knowledge, by Doug White and Derek Angus, JAMA, June 24, 2020 |
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Fair Allocation of Scarce Medical Resources in the Time of Covid-19 by Zeke Emanuel et al. with arguments supporting six recommendations, including that “prioritization guidelines should differ by intervention and should respond to changing scientific evidence,” that priority should be given to “front-line health care workers and others who care for ill patients and who keep critical infrastructure operating, particularly workers who face a high risk of infection and whose training makes them difficult to replace” and that some priority should be given to those “who participate in research to prove the safety and effectiveness of vaccines and therapeutics, NEJM, May 21, 2020 |
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On Being an Elder in a Pandemic, by Larry Churchill, discuss the special obligations he believes elders have during this pandemic, not as a matter of policy, but as the result of embracing a lifespan approach to ethics, April 13, 2020 |
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Covid-19 Crisis Triage — Optimizing Health Outcomes and Disability Rights, arguing that “crisis triage protocols should focus on identifying the patients who are most likely to die without a ventilator yet most likely to survive with one, using the best available clinical survivability scores,” particularly immediate and near-term survival, by Mildred Solomon, Matthew Wynia, and Larry Gostin, May 19, 2020 |
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Respecting Disability Rights — Toward Improved Crisis Standards of Care, arguing for the inclusion of near-term survival, but not long-term life expectancy in policies, among triage criteria in policies regarding allocation of scarce resources like ventilators and ICU, including some comment on some state policies, and recommending four substantive and two process considerations for such policies, by Michelle Mello, Govind Persad, and University of Pittsburgh faculty member, Doug White, May 19, 2020 |
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AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond, from the American Geriatrics Society, arguing against use of criteria such as “life-years saved” and “long-term predicted life expectancy” that might disadvantage older people in the allocation of scarce resources like ventilators, May 6, 2020 |
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Is It Ethical to Unilaterally Withdraw Life-Sustaining Treatment in Triage Circumstances?, analyzing from a Roman Catholic perspective, employing the doctrine of double effect, the question of “whether mechanical ventilation may be unilaterally withdrawn from one patient, who has a relatively poor expected outcome, to benefit another who is predicted to survive to discharge,” May 15, 2020 |
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Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated with Members of the Association of Bioethics Program Directors, characterizing development of ventilator triage policies and comparing policy content, by a Task Force of the Association, April 28, 2020 |
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The Way We Ration Ventilators Is Biased: Not every patient has a fair chance, a New York Times opinion piece by Harald Schmidt, April 15, 2020, prior to the April 15, 2020 revision of the policy discussed When Medical Resources Are Scarce, Doug White’s Letter to the Editor in response, published April 28, 2020 (scroll to the bottom of the letters) |
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Allocation of Scarce Critical Care Resources During a Public Health Emergency: A Model Hospital Policy for Allocating Scarce Critical Care Resources, April 15, 2020, by Doug White, UPMC Endowed Chair for Ethics in Critical Care Medicine, with Scott D. Halpern of the University of Pennsylvania (Original version) A Conversation about Allocating Scarce Resources, with Doug White, as part of the Pandemic Policies & Practices series co-sponsored by the Mid-Atlantic Regional Public Health Training Center and the Center for Bioethics & Health Law, May 12, 2020; the presentation begins at minute 7 |
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A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic by UPMC Endowed Chair for Ethics in Critical Care Medicine Douglas B. White and UCSF’s Bernard Lo, published in JAMA March 27, 2020, with a related JAMA podcast on March 28, 2020 |
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Interim Pennsylvania Crisis Standards of Care for Pandemic Guidelines, developed by the Pennsylvania Department of Health and The Hospital & Healthsystem Association of Pennsylvania, April 10, 2020 (March 22, 2020 version) |
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Fair Allocation of Scarce Medical Resources in the Time of COVID-19 by Ezekiel Emanuel et al. in NEJM, March 23, 2020 |
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The Toughest Triage — Allocating Ventilators in a Pandemic by Robert Truog, Christine Mitchell, and George Daley in NEJM, March 23, 2020 |
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Ventilator Allocation Guidelines—New York State Task Force on Life and the Law, 2015
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Diversity and Solidarity in Response to Covid-19, responding to arguments presented by Ne’eman (April 13, 2020) and others, Govind Persad and David Wasserman argue there “are better ways to address disparities than abandoning the goal of saving more lives,” May 13, 2020 |
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When It Comes to Rationing, Disability Rights Law Prohibits More than Prejudice, by Ari Ne’eman, April 10, 2020 |
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US Civil Rights Office Rejects Rationing Medical Care Based on Disability, Age—New York Times, March 28, 2020 |
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Preventing Discrimination in the Treatment of COVID-19 Patients: The Illegality of Medical Rationing on the Basis of Disability, Disability Rights Education & Defense Fund, March 25, 2020 |
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If Covid-19 gets bad, triage will be needed. Are we ready for that?, a STAT First Opinion, by Matthew Wynia & John Hick providing an overview of ethical principles and considerations in making triage decisions for COVID19, March 10, 2020 |
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Minnesota Department of Health clinical guidance on triage: Patient Care Strategies for Scarce Resource Situations. This includes specific guidance for shortages of oxygen (section 1), hemodynamic support (section 5), ventilators (Section 6), and ECMO (section 12) among other resources |
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From the CDC: Strategies for Optimizing the Supply of N95 Respirators, updated February 29, 2020 |
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Guidance on pandemic influenza from the Pandemic Influenza Ethics Initiative Work Group of the Veteran’s Health Administration’s National Center for Ethics in Health Care (2010): |
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HHS Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) resource page on crisis standards of care |
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Care of the Critically Ill and Injured During Pandemics and Disasters: Chest Consensus Statement (2014) |