Prioritizing trust and consistency when allocating ventilators

By Alexander T.M. Cheung and Brendan Parent

Rationing healthcare resources never sits well with all parties involved. By definition, someone gets left out. Various values, contrary perspectives, and practical considerations all must be weighed before reaching a morally passable, though imperfect, compromise. Yet never has the question of rationing so acutely needed answering in the United States until COVID-19.

While ventilators took center-stage during rationing discussions at the outset of the pandemic, the list of medical resources stretched paper-thin extends far beyond the intensive care unit. Personal protective equipment (PPE) shortages continue to afflict healthcare facilities, and access to affordable testing has been inconsistent across the nation. With the prospect of an authorized vaccine on the distant horizon, the debate has arisen anew: Who gets priority for the first shots? Who pays? And how much?

Because the outcomes cannot appease everyone, we have to use decision-making processes that most people can tolerate, if not completely accept. The analogy of a sporting match works well here: so long as everyone accepts and respects the rules of play, the final score may be unfavorable to some—but not inherently unfair.

In our recent article, we focus on the process of ventilator allocation and what is at stake when triage policies prioritize certain groups like healthcare workers over others. These circumstances can build a climate of (mis)trust that enables or discounts COVID-19 conspiracy theories, which medicine cannot ignore. Even outlandish misinformation regarding mask usage and vaccine production can have a very real impact on public health outcomes. Given the risks of this environment, we couldn’t help but wonder how the prioritization of healthcare workers for ventilators might affect public perceptions of favoritism, and how it could exacerbate already pervasive suspicions of the healthcare system.

Before the pandemic, several groups of experts came together and spent countless hours crafting different ventilator allocation policies to prepare for the world we now find ourselves inhabiting. The policy-crafters made painstaking efforts to ensure their recommendations adhere to ethical principles like justice, the duty to care, and maximizing lives saved.  Strangely, some policies and their crafters make inexplicable jumps outside their own espoused “rules of play” to justify healthcare workers cutting to the front of the line. And, some institutions have not made their policies publicly available. To be clear: healthcare workers might ethically be prioritized—but not at the expense of transparency and consistency.

The route of redress is quite apparent: let people know the agreed-upon rules and play by them. This way, policies can both ethically allocate scarce resources and foster trust in the healthcare system. At a time when the U.S. faces a record-breaking number of daily COVID-19 cases, it is imperative for medicine to regain and maintain the public’s trust.


Paper title: Mistrust and inconsistency during COVID-19: considerations for resource allocation guidelines that prioritise healthcare workers

Authors: Alexander T.M. Cheung and Brendan Parent

Affiliation: Division of Medical Ethics, New York University School of Medicine, New York, New York, USA

Competing interests: The authors declare no competing interests.

Social media accounts of post authors: Twitter: @alexorscanner @parent_brendan

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