Include public opinion when making medical rationing frameworks – Boston, Massachusetts

Boston, Massachusetts 2020-11-20 04:45:53 –

WIt is certain that the Covid-19 vaccine will be available and supply will be limited, but who needs to get it?

It depends on who you ask.

Harris Paul released survey data in August, showing how the public believes that future Covid-19 vaccines should be given. The results were relatively intuitive. Citizens wanted first doses for healthcare workers (73%), people over 55 (71%), key workers (60%), and first responders (56%).


While this public view is important, it rarely informs frameworks created by scholars and government officials to allocate scarce medical resources such as vaccines and ventilators. You need to change that. Public opinion should be taken into account each time a medical ration problem arises.

Take a ventilator as an example. Currently, there is no unified national framework to guide medical distribution decisions regarding the use of ventilators in hospitals and emergency departments. States such as New York and Washington had developed critical standard treatment guidelines before the pandemic occurred. Others, such as New Jersey and Massachusetts, followed in the early stages of Covid-19.


Hospital systems often create their own triage standards or follow the initiative of other institutions. For example, at the beginning of the pandemic, a framework developed by faculty members at the University of Pittsburgh School of Medicine outlined guidelines for the allocation of ventilators and critical care beds. This framework has been adopted by hundreds of hospitals.

Over the years, academic bioethicists have written dozens of pandemic-specific treatises, as well as hundreds of treatises outlining the framework of the distribution of various rare medical resources.

While these institutional and academic insights are informative, policy conversations like these should also include the general public.

In March, an international group of 10 bioethicists, legal scholars, public health professionals and others took an approach to the “fair distribution of scarce medical resources” during the Covid-19 pandemic at the New England Journal of Medicine. Announced to the medicine. The authors, much like the University of Pittsburgh guidelines, “save the most personal lives” (meaning to save the most people) and “save the most lives” (save the most lives). We promoted a framework that weighs competing ethical principles such as (meaning). The number of years that may be preserved in each person’s life to make a ration decision). Although this article was well-studied and thought-provoking, it is also controversial, as critics argued that “saving the most lives” discriminates against the elderly and disabled.

A diverse group of scholars, including conservative scholar Ryan Anderson and progressive icon Cornel West, have announced a reunion. Twenty signatories have made exceptions to the guideline that when competing for the same scarce medical resources, they are in fact overly dependent on a lifelong approach that favors younger patients than older ones. Based on the slippery slope argument, the authors hypothesized whether to reject the ventilator at age 50 and give it to age 30, that is, whether it could maintain a longer lifespan. I asked a question. Does 30 need to lose to 15?

These authors also expressed concern about the rejection of ventilators by patients with mental or physical disabilities, prioritizing more “competent” individuals. Such concerns have been highlighted elsewhere as Massachusetts disability rights activists persuaded the state to change its distribution guidelines shortly after it was published. Activists in Alabama and Pennsylvania did the same, forcing the US Department of Health and Social Welfare to issue multiple statements addressing these fears of discrimination against persons with disabilities.

Experiences in Massachusetts, Pennsylvania, and Alabama show that large-scale medical decisions are political in nature. Therefore, policy makers, in addition to the opinions of experts from the medical and academic circles, hear from public opinion, especially the color communities most affected by Covid-19 and individuals below the median income. You need to consider. Public policy should ultimately be informed by public opinion.

The Pew Research Center regularly conducts polls on bioethical issues such as developmental gene editing, human genetic enhancement, and assisted suicide by physicians. These insights are also useful to scholars, policy makers, and the general public. Conducting similar polls on vaccine and ventilator deficiencies during a pandemic is still fresh in the public mind, but as valuable to policy makers as state-led civil focus groups. It can be a thing. Washington offers outstanding case studies to do this.

In a series of seven hearings in 2018, Washington state health officials urged residents to consider the medical distribution dilemma associated with potential pandemics. Residents were asked what to prioritize and what not to prioritize when deciding who should benefit from limited health resources. The debate provided a “rich discussion” of ethics and social usefulness among diverse populations, and ultimately informed Washington’s Standard Treatment Guidelines for Crisis. State and federal policy makers need to trust the ethical beliefs of their people and follow state examples.

Medical ration is one of the most feared concepts in medicine. This phrase is often used as a political weapon. However, especially in a pandemic, we need to discuss the allocation of rare medical resources such as ventilators and vaccines. Recalling the American motto “epluribus unum”, the opinion of “pluribus” was chosen so that it could create an ethical framework for, and together with, all Americans. You need to balance it with “unum”.

Mark E. Dornauer is a Visiting Researcher in Healthcare at the Foundation for Research for Equal Opportunity.

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