The ethical pitfalls of prioritising healthcare workers for ventilators during Covid-19

By Lois Shepherd, Donna T. Chen, Jordan Taylor, Mary Faith Marshall

Early in the Covid-19 pandemic hospitals and health systems scrambled to create and adopt guidelines for rationing critical care resources in the event of scarcity.  A major focus of those guidelines was how to allocate ventilators—namely, who would get a hospital’s last ventilator when two or more patients needed it?  Healthcare workers were overburdened, believed to be at high occupational risk for exposure, and often called to work outside their regular scope of practice.  Should they be given some priority?

As ethics consultants and educators in an academic health system, we were part of a 20+ member multi-disciplinary group assembled at our medical center to prepare an allocation system in the event that one was needed.  Early drafts from health systems around the country were being shared in a collective effort to get this right.  A significant number of them (including a prominent policy promoted by its drafters as a model), prioritized healthcare workers in some way—usually as a tie-breaker.

Our own medical center’s multi-disciplinary allocation group decided, with little disagreement, not to prioritize healthcare or any other essential workers; to do so did not feel right to the members of the group.  But giving healthcare workers priority for scarce ventilators clearly holds some appeal, and the various hospital committees within our region made different decisions on this point.  Some cited high-profile academic and popular press articles that supported doing so. These pieces argued that prioritizing healthcare workers was justified to keep essential health care functions running and/or to reward healthcare workers’ special service.

We agreed with other members of our medical center’s allocation group that healthcare workers should not be prioritized and were not persuaded by the recommendations made otherwise in the literature.  We are surprised that more ethicists have not formally challenged decisions to prioritize healthcare workers, especially as the policies adopted and arguments made in this health crisis will likely serve as precedents for the next one. We conducted a formal ethical analysis of the issues we saw to be at stake.  As our paper shows, we determined that the ethical arguments most frequently used to justify such a prioritization were insufficient to abandon the common moral commitment to value each person’s life equally.  We identified potential harms to healthcare professionals, health systems, and society from doing so.


Paper title: Who will receive the last ventilator: Why COVID-19 policies should not prioritize healthcare workers

Author(s): Donna T. Chen, Lois Shepherd, Jordan Taylor, Mary Faith Marshall

Affiliation for all authors:  Center for Health Humanities and Ethics, University of Virginia School of Medicine, Charlottesville, VA, USA

Competing interests: The authors declare no competing interests.

Social media accounts of post author(s): twitter: @loislshepherd @UvaCHHE

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