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Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions
- Douglas B. White, MD, MAS;
- Mitchell H. Katz, MD;
- John M. Luce, MD; and
- Bernard Lo, MD
- From the University of California, San Francisco, School of Medicine; University of California, San Francisco; San Francisco Department of Public Health; and San Francisco General Hospital, San Francisco, California.
Abstract
A public health emergency, such as an influenza pandemic, will lead to shortages of mechanical ventilators, critical care beds, and other potentially life-saving treatments. Difficult decisions about who will and will not receive these scarce resources will have to be made. Existing recommendations reflect a narrow utilitarian perspective, in which allocation decisions are based primarily on patients' chances of survival to hospital discharge. Certain patient groups, such as the elderly and those with functional impairment, are denied access to potentially life-saving treatments on the basis of additional allocation criteria. We analyze the ethical principles that could guide allocation and propose an allocation strategy that incorporates and balances multiple morally relevant considerations, including saving the most lives, maximizing the number of “life-years” saved, and prioritizing patients who have had the least chance to live through life's stages. We also argue that these principles are relevant to all patients and therefore should be applied to all patients, rather than selectively to the elderly, those with functional impairment, and those with certain chronic conditions. We discuss strategies to engage the public in setting the priorities that will guide allocation of scarce life-sustaining treatments during a public health emergency.
Article and Author Information
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Potential Financial Conflicts of Interest: Consultancies: B. Lo (Centers for Disease Control and Prevention Ethics Subcommittee to Advisory Committee to Director).
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Grant Support: By grant KL2 RR024130 from the National Center for Research Resources, a component of the NIH and NIH Roadmap for Medical Research and by the Greenwall Foundation.
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Requests for Single Reprints: Douglas B. White, MD, MAS, University of California, San Francisco, Program in Medical Ethics, 521 Parnassus Avenue, Suite C-126, Box 0903, San Francisco, CA 94143-0903; e-mail, dwhite{at}medicine.ucsf.edu.
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Current Author Addresses: Drs. White and Lo: University of California, San Francisco, Program in Medical Ethics, 521 Parnassus Avenue, Suite C-126, Box 0903, San Francisco, CA 94143-0903.
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Dr. Katz: 101 Grove Street, Room 308, San Francisco, CA 94102.
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Dr. Luce: San Francisco General Hospital, 1001 Potrero Avenue, Room 5 K1, San Francisco, CA 94110.
