Do ventilator allocation guidelines misrepresent minority communities?

Covid-19, Drugs

A recent review examined the contribution of members from disadvantaged communities in creating the guiding principles for ventilator allocation.

Ethical guidelines regarding the allocation of scarce resources in medicine have long been debated by experts and community members.

The problem of rationing ventilators has become particularly salient during the current COVID-19 pandemic. With a limited number of ventilators available to hospitals, unfortunate and unavoidable dilemmas arise regarding who gets it first.

The current guidelines for ventilator triage use controversial utilitarian principles, focusing on saving the most lives, and/or the most life-years. In other words, the guidelines suggest prioritizing those that would most likely survive by receiving the ventilators, as well as those who are youngest.

The authors of such guidelines often report surveying both the experts as well as the communities to create these principles. However, as disadvantaged communities in the United States have been affected more severely by the COVID-19 pandemic, it is important to examine how minority communities view the issue of ventilator allocation.

As published in the Journal of Medical Ethics, researchers conducted a review of literature to examine this issue. The review included six studies with a sample totaling over 10,000 participants.

Furthermore, in one study the researchers found that younger participants were much less likely favor saving the most lives, as compared with older participants. Another study showed that those younger than 60 years of age were significantly more likely to object to the life cycle criterion (i.e. prioritizing patients with the most life-years left). Still another study found that 58% of participants under 30 years of age preferred saving the most lives, while 57% of participants over 50 years of age preferred help the worst off.

Important to note is the fact that the researchers found only a very small number of studies that included community preference measures. Of these six studies, only one-half reported measures by race, income and age. This significant limitation hinders the understanding of the involvement of disadvantaged communities in the preferences guiding resource allocation.

According to the authors, of the available data, the overall trend shows that participants from disadvantaged communities preferring criteria that would increase their chance of receiving the ventilator. This finding is in contrast with the criteria of saving the most lives, and the most life-years, which favors those with the best baseline health.

The researchers call for more intensive studies examining the issue of ventilator allocation in minority communities, particularly as it relates to issues influenced by systemic inequality.

Written by Maor Bernshtein

Reference: Kerr, W., &  Schmidt, H. (2020). COVID-19 ventilator rationing protocols: why we need to know more about the views of those with most to lose. Journal of Medical Ethics. doi: 10.1136/medethics-2020-106948.

Image by Thiago Lazarino from Pixabay 

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