COVID-19 Triage, Allocation Decisions Must Be Guided by Ethical Principles and Values

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The COVID-19 pandemic has forced health care systems to face difficult decisions regarding triage, allocation and reallocation of medical resources. As health care systems discuss and plan for a potential resurgence of COVID-19, decision-making should be guided by ethical principles and values, should not be made before crisis standards have been declared by authorities, and, in most cases, will not be made by bedside clinicians, according to an article published May 8 in the Journal of the American College of Cardiology.

James N. Kirkpatrick, MD, FACC, et al., aimed to provide a document that helps clinicians meet the challenges of the current pandemic by describing clinical and ethical issues surrounding triage and rationing decisions, and providing recommendations for cardiovascular clinicians. The authors of the study have expertise in cardioethics, palliative care and geriatric cardiology.

The document includes recommendations on important elements in triage, allocation and patient care in the setting of the COVID-19 pandemic. The authors consider the principles and values for allocation of scarce medical resources, resuscitation decisions, withholding and withdrawing life-sustaining therapies, and fiduciary duties in a crisis, while recognizing there are unique considerations during a pandemic. The authors also stress the importance of transparent and clear communication and providing the best possible care to patients.

"The COVID-19 pandemic has stretched the resources of many [health care] institutions and threatens to do so again in a resurgence," write the authors.

"Difficult decisions about allocating these resources will follow principles and values, some of which may diverge from the autonomy-based decision-making systems predominant during conventional situations. Contingency and crisis standards of care in the face of a disaster change the way we practice cardiovascular medicine, but the duties of cardiovascular clinicians remain focused on individual patients."

Clinical Topics: Geriatric Cardiology

Keywords: United States, Aged, Triage, Pandemics, Palliative Care, COVID-19, Standard of Care, severe acute respiratory syndrome coronavirus 2, Health Resources, Disasters, Decision Making, Hospice and Palliative Care Nursing, Resource Allocation, Coronavirus, Coronavirus Infections


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