The principles that physicians act in the best interest of and avoid causing net harm to their patients. Since the scarcity of resources in a pandemic crisis raises conflict between clinicians’ commitment to individual patients and their duty to promote and protect public health, a triage team separate from the bedside physicians must triage patients.

Beneficence/non-maleficence and pandemic

The principle that a patient's access to scarce resources is determined by the urgency of the patient's need and their likelihood of benefiting from treatment, regardless of age, sex or gender identity, race or ethnicity, religion, socioeconomic status, religion, and assumed VIP status. During a pandemic, resource allocation may raise issues of discrimination based on age or pre-existing conditions.

Justice and pandemic

The principle that, when resources are limited, the young should be prioritized over the elderly because 1) all people have the right to experience all life stages and 2) advanced age is correlated with decreased physical resilience, so to achieve maximization of life-years saved, we must consider age in triage criteria. Some argue that fair innings leads to age discrimination.


Fair innings and pandemic

The notion that certain individuals, particularly healthcare workers, should receive priority access to limited resources because of 1) their instrumental value to society and 2) our urgent need to return them to the workforce so that they can continue treating patients. Prioritization also reduces voluntary absenteeism. Opponents argue this principle is difficult to implement and can devolve into discrimination.


Instrumental value and pandemic

With the pandemic occurring, medical necessities such as ventilators and medicine become very scarce. They are experiencing critical shortages of tools. The healthcare workers have to decide who to  administer the euqpiment and medication to. They have to decide who needs it most without risking the lives of other workers and patients. They also have to be ready if another wave occurs. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936949/

Can the Health-Care System Meet the Challenge of Pandemic Flu? Planning, Ethical, and Workforce Considerations

Usually, clinicians cannot withhold or withdraw medically necessary treatment without the patient's (or surrogate's) consent, but in pandemic crises, healthcare systems supersede autonomy to maximize public health through allocation and rationing of resources.


Infringement of medical autonomy in the COVID-19 pandemic

The principles of medical ethics are:
- Autonomy
- Beneficence/non-maleficence
- Justice
- Fair innings
- Instrumental value

Syracuse University

University of Michigan - Ann Arbor

During the COVID-19 pandemic, healthcare systems faced severe operational challenges due to massive patient influxes and critical shortages of medical resources. To manage these constraints, systems adopted crisis standards of care and established specialized triage teams for resource allocation. These difficult decisions were guided by strict medical ethics rather than individual bedside clinicians to ensure fairness and reduce moral distress, while healthcare workers simultaneously navigated heightened risks of occupational infection.

Healthcare Systems During the COVID-19 Pandemic

Kirkpatrick, J. N., Hull, S. C., Fedson, S., Mullen, B., & Goodlin, S. J. (2020). Scarce-Resource Allocation and Patient Triage During the COVID-19 Pandemic. Journal of the American College of Cardiology, 76(1), 85-92. 
doi:10.1016/j.jacc.2020.05.006
https://www.sciencedirect.com/science/article/pii/S0735109720352232?via%3Dihub

Scarce-Resource Allocation and Patient Triage During the COVID-19 Pandemic

- Journal of the American College of Cardiology
- The Lancet Public Health 
- Clinical Chemistry and Laboratory Medicine (CCLM)
- US National Library of Medicine National Institutes of Health
- Journal of the Association for Consumer Research

References for Healthcare Systems During COVID-19 Pandemic by Journal

Scarce resources include, but are not limited to, intensive care unit (ICU) beds, ventilators, dialysis machines, extra-corporeal membrane oxygenation circuits, personal protective equipment (PPE), and healthcare workers.


Scarce Resources for Healthcare Systems During COVID-19

The standards of care, or criteria for healthcare system guidelines during the pandemic, are as follows:
- Conventional standard 
- Contingency standards
- Crisis standards

Standards of Care in COVID-19

In hospitals, triage teams reduce moral distress for clinicians and legally protect them by deciding 1) which patients should receive allocation (life-sustaining intervention) and 2) whether resources will be withdrawn from one patient and given to another. They must be transparent about their principles and decision-making factors, but the team member identities may be private. 

Triage Teams for Healthcare Systems and COVID-19

- Healthcare workers have been shown to be at a largely increased risk for becoming infected with COVID-19 while compared to the general public
- Factors that affect this finding include testing, PPE, ethnic factors, and clinical setting


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