8: Resource Allocation - Reading Flashcards
T or F: allocation of limited resources during a global health emergency is normal practice for most physicians/surgeons
F: it is not
4 principles found in patient-physician relationships
○ Beneficence: acting in best interest of others
○ Justice: treating people fairly, impartially, equitably
○ Autonomy: self-determination, making one’s own choices
○ Non-maleficence: doing no harm/acting to avoid harm
T or F: during a global health emergency with limited resources, not fulfilling the demands of a patient does not deny the patient’s autonomy, yet acknowledges not all requests can be met atm
T
T or F: all values aiding in the decision making process of reallocation of resources must be fulfilled simultaneously
F: impossible to fulfill them all simultaneously
Fundamental values to apply during a pandemic
○ Maximizing benefits
○ Most lives saves
○ Most life-years gained
○ Equal treatment
○ Lottery system
○ First-come, first serve
○ Prioritize the worst off
**maximizing benefit
a) most lives saved: each individual is valuable
- 5 lives over 1 needs little justification
- pandemic is not equal… save 3 old people w 5yr left vs 1 young person with 60yr left?
b) most life-years gained
- 5 people with 40yr left vs 5 people w 4yr left
- limitations: does not account for distribution of life-years
- is 20 ppl 1yr = 4ppl 5yrs?
**both insufficient alone
**treating people equally
*every person is granted same moral status, and desire to stay alive is of = importance
a) lottery system: quick, easy, requires little knowledge of individuals, resists corruption
- doesn’t take into account relevant knowledge of patients (prognosis, life-years .etc)
- insufficient alone, good in larger systems between patients with similar expected benefit
b) first-come, first-serve: flaws unique to disaster siutaions
i. doesn’t treat all equally = favours more advantaged people (financial resources, connections.etc)
ii. can favour community members who are non-compliant with pandemic strategies (ex. isolation)
- become infected sooner, get resources sooner
iii. doesn’t maximize benefit of available resources
- if 1st serve patient consumes a lot/ongoing amount of resources, later patients are denied of them
Is it ethically justifiable to remove resources from 1 early patient with a poor prognosis to provide benefit to several subsequent patients with a better prognosis in pandemic conditions?
Yes
- first-come, first-serve basis laws
**Rewarding Instrumental Value
people with direct value to helping pandemic can be one of the limited resources
- healthcare professionals, first responders, scientists .etc
- have an INSTRUMENTAL VALUE to society
*social value is different than instrumental
- may benefit to society as a whole, but have no benefit to fighting a pandemic
- shouldn’t direct allocation of scarce resources
*RECIPROCITY is crucial to maintaining engaged/committed workforce
- include provisions that protect them, ensuring their sacrifice won’t go unnoticed if they get sick
**Giving priority to the worst off
**does not take into account relevant concerns in a pandemic (post-treatment prognosis)
- poor prognosis for recovery might require a lot of resources (ex. mechanical ventilation for weeks)
- unavailable to several that may survive if redirected to them
- may not provide good guidance when maximizing benefit from resources is important
*infants may be considered worst off - excludes elderly
*modifying youngest first approach maximizes opportunity to live thru various phases of life
- adolescents received considerable societal investment of education/upbringing, have many life cycles ahead that pandemic will cut short
- infants have no investment, elderly have already expereinced = lower priority
T or F: Those with non-pandemic conditions should not be favored or less favored over those presenting from the pandemic
T: they still need care
unrelated surgical care during COVID-19
- Clinical and surgical practices may not be standard or safe during pandemic
- ex. elective surgeries should be postponed, screen for COVID 24hrs before, self-isolate
- practices are altered compared to standard care, yet remain consistent with ethical principles applied during pandemics
○ Ex. redirecting hospital/ICU beds from elective surgical patients to pandemic patients is consistent with maximizing benefits of limited resources
What is a valuable partner to medical community during pandemic
informed and trusting public
- Trust in medical community will be better maintained when:
- receiving honest, accurate and transparent communication
- see the medical community consistently applying treatment and triage practices being professed
T or F: Applying values into an allocation framework with proper weight can follow one standard guideline
F:
○ No 1 fundamental value that can be applied in pandemics and will perfectly determine the distribution of limited resources
○Application of MULTIPLE VALUES guide us
○ Weight given to each one will vary from one healthcare emergency to another
Who makes up the best team to declare an allocation framework to guide decisions in a pandemic?
Clinical Triage Teams
- consisting of multiple stakeholders to help make difficult decisions
○ Enhances objectivity in decision-making process, reduces conflicts of interest, decrease the moral distress of front-line providers
- relive front-line workers from doing so
