The Sequential Organ Failure Assessment (SOFA) and revised ventilator triage guidance: since we are still implementing outdated and more inequitable frameworks now, will we learn any lessons longer term?

By Harald Schmidt, Dorothy E Roberts,  Amaka D Eneanya Ventilator triage guidance can reduce, maintain, or exacerbate existing social, racial and ethnic health inequities, raising non-trivial legal issues. Over the last 18 months, there has been an intense reckoning with the fact that traditional rationing frameworks focused on maximizing overall benefits tend to worsen Covid-19’s disparate impact on disadvantaged communities of color. Yet, as ICUs […]

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Helping global neighbors during the COVID-19 pandemic

By Nancy S. Jecker, Aaron G. Wightman, Douglas S. Diekema Why should high-income nations help their global neighbors during a pandemic emergency?  If they help, what is a just way to distribute the goods and services they make available?  In “Vaccine Ethics: An Ethical Framework for Global Distribution of COVID-19 Vaccines,” we take up these […]

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Does the public think age matters in COVID-19 triage?

By Margot N I Kuylen On what basis should we allocate resources when resources are scarce? The COVID-19 pandemic has made this complex ethical question extremely salient, as newspapers reported at various points that critical care units across the world were reaching, or even exceeding, their capacity. A wealth of triage guidance has been published […]

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Is vaccination status an acceptable factor in triage?

By Angela Wentz Faulconer. More than 625,000 people in the United States and over 4.4 million people worldwide have died from Covid-19. As the Delta variant surges, many hospitals find themselves caring for patients in hallways, with no ECMO available and every ICU bed taken. A growing number of physicians have suggested that as hospitals become overwhelmed, we might weigh vaccination status as […]

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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 […]

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Balancing speed and equity in the rollout of COVID-19 vaccines

By Maxwell J. Smith COVID-19 vaccines are in limited supply, and so it’s crucial that their harm-reducing powers are deployed strategically. This likely requires two things: (1) prioritizing vaccines to those at greatest risk of mortality, hospitalization, transmission, and/or infection; and (2) administering vaccinations as rapidly as possible. Yet, it is sometimes not possible to […]

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Paying more for highly specialised technologies: equity or profligacy?

By Jonathan Michaels The National Institute for Health and Care Excellence (NICE) recently consulted on possible revisions to its processes for health technology evaluation.  An important aspect of the proposed changes related to topic selection criteria for the Highly Specialised Technologies (HST) programme.  This is of great commercial interest as it allows some technologies to […]

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When the going gets tough, where do persons with disabilities stand? Covid-19 pandemic, community-centered medicine and scarce health resources allocation

By Nicola Panocchia, Viola D’Ambrosio, Serafino Corti, Eluisa Lo Presti, Marco Bertelli, Maria Luisa Scattoni, and Filippo Ghelma The COVID-19 pandemic led to a shift in the medical paradigm from person-centered medicine to community-centered medicine. This shift gives “priority to community health above that of the individual patient in allocating scarce resources”. The patient-physician relationship […]

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