Healthcare Rationing During COVID-19: Ethical Challenges, Medical Dilemmas, and Policy Implications Essay

Introduction to Healthcare Rationing During the COVID-19 Pandemic

The COVID-19 pandemic, like other pandemics in the past, presented doctors with the need to make emergency healthcare choices to save lives. During emergency decision-making, doctors face medical dilemmas, such as the need for healthcare rationing. Healthcare rationing requires doctors to prioritize patient care during a scarcity of healthcare resources.

However, there are no standard guidelines for conducting healthcare rationing. There are several ways through which doctors can run healthcare rationing despite facing differing opinions from other professionals and patients. Healthcare rationing remains a complex and uncertain aspect of healthcare, where various perspectives from patients, economists, politicians, and medical professionals influence its nature.

The Need for Healthcare Rationing in Medical Emergencies

The need for healthcare rationing arises during emergencies in the medical practice. During the Corona Virus Disease COVID-19 and the exploding numbers of patients requiring ventilator support, doctors prioritized which patients to be supported by ventilators and other equipment (Fink, 2020). The situation arose when hospitals faced a massive shortage of equipment, staffing, and other medical supplies.

Besides, the pandemic suddenly affected the hospital budgets and funding for some everyday aspects since so many patients sought care. Some persons may rely on healthcare rationing to manage resource shortages (Hauge et al., 2022). According to individuals who believe life is precious and always worth saving, “if it is possible to save a life, every effort should be made to do so” (Dieteren et al., 2020, p. 340). However, healthcare rationing has been an option during previous pandemics and mass casualty situations. Therefore, medical professionals, including nurses, have access to multiple options in dealing with healthcare rationing.

Challenges and Controversies in Healthcare Rationing

Moreover, healthcare rationing remains a challenging aspect of medical practice. While healthcare professionals face frequent medical dilemmas where they have to choose, health rationing is challenging since there are multiple aspects to consider. There is no guarantee of mutual support for healthcare rationing in pressing situations like COVID-19 since people hold different viewpoints, and “it remains unclear whether there would be societal support for a lifestyle criterion for the healthcare priority setting” (Dieteren et al., 2020, p. 333). For instance, questions on who makes a choice, how to justify any decision to the public, or whether, once placed under a ventilator, the patient owns it until they recover make most doctors want to avoid healthcare rationing (Fink, 2020).

According to Hauge et al., without justification of medical actions to the public, “illegitimate decisions prompt public resistance” (Hauge et al., 2022, p. 1293). Moreover, doctors have guiding principles that guide their practice. Further, sustaining life is one of the medical goals; hence, healthcare rationing may jeopardize the need to save lives. Therefore, the need to set guidelines for healthcare rationing makes the process problematic.

Disagreements Among Medical Professionals on Healthcare Rationing

First, healthcare rationing becomes more problematic when doctors hold disagreeing opinions. Naturally, such a challenging aspect would attract different views from medical experts. In China, doctors were forced to turn sick people away from hospitals, while in Italy, doctors denied ventilators to older and sicker patients to give to younger, healthier patients (Fink, 2020). While some doctors may prioritize healthcare for younger patients, others prefer older patients. All doctors have supportive points for their arguments, but no one can tell who is right or who made the better choice.

For instance, using age as a factor for health rationing, a doctor asks, “Is a 20-year-old more valuable than a 50-year-old, or are 50-year-olds actually more useful for your economy because they have experience and skills that 20-year-olds do not have? “(Fink, 2020, p. 3). Bioethical studies on healthcare rationing indicate concern over the bias that may arise over criteria used to prioritize patient treatment, such as “a clinician’s individual bias” (Hauge et al., 2022, p. 1294). Hence, existing uncertainty over how or when to conduct healthcare rationing presents a dilemma to medical practitioners.

Secondly, healthcare rationing remains problematic since several differing views exist on healthcare rationing, and people need to learn the right or wrong way. According to some doctors, “choosing patients goes against what we used to think about our profession, against the way we think about our behavior with patients” (Fink, 2020, p. 1). However, in the United States, there are indirect guidelines, such as grants, for healthcare rationing during a severe pandemic like COVID-19.

Other concerns include avoiding bias against people with disabilities or racial bias while carrying out healthcare rationing. Besides, minimal research has been done to determine whether the rationing guidelines may save lives or cause more deaths. Other doctors have developed some guidelines to help in rationing. For instance, some may use the triage method, where medical personnel should attend to the most dangerously wounded patients before attending to other patients or those with severe symptoms in the case of COVID-19 (Fink, 2020). Therefore, while avoiding unethical medical practices, some doctors seek to do the best for most patients and fairly administer healthcare.

Sociological, Economic, and Political Perspectives on Healthcare Rationing

Further, several other perspectives influence opinions on healthcare rationing that may make some individuals uncomfortable. Sociological, political, economic, and bioethical views exist on healthcare rationing (Hauge et al., 2022). Moreover, some forms of rationing need to be scrapped in the quest to practice justice for all patients. For instance, denying care to patients with pre-existing health conditions such as diabetes and high blood pressure substantially excludes such patients from recovery. Moreover, pre-existing conditions do not determine a patient’s recovery. Dr. Lee Daugherty Biddison mentions that “preconditions do not always predict survival from respiratory viruses and having chronic diseases like diabetes, kidney failure, and high blood pressure often tracks with access to medical care” (Fink, 2020, p. 3).

Healthcare rationing may become necessary, especially during a global pandemic like COVID-19. In other circumstances, such as scarcity of medical resources, improvisation may help to avoid healthcare rationing; as Dr. Evans states, “It was an improvisation that prevented tragic rationing at Bellevue” (Fink, 2020, p. 4). However, there are no universal guidelines for healthcare rationing. Existing healthcare rationing methods include excluding elderly patients from ventilator support, while other medical experts suggest asking the patient for consent (Fink, 2020). Thus, healthcare rationing is influenced by multiple views upon which doctors must make decisions.

The Role of Bioethics in Healthcare Rationing

While healthcare rationing is a complex medical aspect, it may be necessary to conduct it to save lives. However, medical experts struggle over who should be left to live and who should be left to die (Fink, 2020). Bioethics also influences the choice for healthcare rationing over its concern for “allocative justice” since implicit rationing may “obscure potentially discriminatory principles such as resource distribution” (Hauge et al., 2022, p. 1294).

Additionally, there is a need for legitimacy in medical practices, including healthcare rationing. Therefore, opinions over healthcare rationing may depend on the extremity of a situation, including instances where medical experts cannot improvise. Since minimal research exists on situations requiring healthcare rationing, bioethics and other codes of conduct in healthcare practice should inform healthcare rationing.

Vulnerable Patients and the Impact of Healthcare Rationing

Healthcare rationing is a complex and sensitive aspect that medical professionals face, especially in pandemics like COVID-19. It is complex because doctors do not want to choose between patients whom to prioritize during care. The absence of guidelines on healthcare rationing gives nurses and doctors a tough time in decision-making, for example, during a shortage of healthcare equipment. However, with improvisation and reliance on humanity, healthcare professionals can avoid healthcare rationing since no doctor can choose which patient should live or die.

In many cases, vulnerable patients suffer a violation of their rights or a lack of options when they visit healthcare facilities with limited resources. For instance, in some countries, including Norway, patients’ conditions worsen when they learn that the required treatment is unavailable (Brendbekken et al., 2022). For example, a Norwegian patient says they wish for death when they lack access to treatment (Brendbekken et al., 2022). Consequently, some discussions in Norway led to immediate intervention and threatened to sue for this discrimination (Brendbekken et al., 2022). The protesters’ demands were anchored in the constitution with support from UNICEF lawyers in the country (Brendbekken et al., 2022).

However, the justified reasons each practitioner gives are diverse; all of them argue right according to their views (Fink, 2020). With their crucial goal of saving people’s lives first, the doctors face a challenge in considering who should be protected and who will not be saved. According to Fink’s article, choosing between patients “goes against the way we used to think about our profession, against the way we think about our behavior with patients” (2020, p. 1). Therefore, some hospitals withhold treatment according to the stage or severity of the illness.

Addressing Healthcare Rationing Issues

A few issues need to be addressed to resolve the healthcare rationing challenges. Proper planning and implementation of policies are major subjects that every stakeholder should value for the success of resource allocations. There is a deliberate need for an informed political and social system to explicitly direct medical management procedures and reliable methods of rationing care requirements.

Fink (2020) states that “officials from various states, medical associations, and hospitals are discussing their own plans” (p.4). This, in return, results in diverse ideas from medical professionals about how to handle life-and-death matters. Superscribing the problem effectively empowers society to mitigate the unspoken characteristics of inequalities, enact policies, and keep well with societal goals (Aziz & Brandl, 2021). For instance, during the COVID-19 pandemic, the shortage of personal protective equipment for the elderly and chronically ill patients was caused by poor policy decisions and bad planning.

Deciding and framing clear guidelines would be one of the protocols to be considered when allocating resources to patients. Fairness and transparency are ethical values that should be prioritized in building long-term benefits in the health sector (Srinivas et al., 2021). For a system to be, uniformity, accountability, generality, and honesty are vital pillars that every individual should consider—clarifying how resources would be allocated among departments involves informing the public about the process and how it is being done (Fink, 2020).

The rationing process requires inclusiveness whereby the allocating persons must revise and challenge the set guidelines (Aziz & Brandl, 2021). The procedure should be consistent and follow the guiding principles to avoid favoritism. According to Fink (2020), “the medical director of the intensive care unit had to choose which patients’ lives would be supported by ventilators and other equipment” (p. 4). Therefore, patients in the intensive care unit should be given ventilators, and more nurses should be allocated to handle the patients without getting divided attention.

It is hard to maintain these resources because each individual has the right to treatment regardless of the facilitation of the materials from the professionals. Rationing is one of the tools that medical practitioners consider critical regarding ethical values in their practice. The issue of rationing is inevitable; therefore, the implementation process should be consideredso as not to affect the ethical values of the applicants(Aziz & Brandl, 2021).

Beneficence, autonomy, and distributive fairness are the main concepts that must be balanced to ensure equity is well-served among the people. Fink (2020) states that “decisions should be made by designated triage officers, not individual doctors caring for patients, and there should be a limited appeals process in cases of resource withdrawal” (p. 3). Therefore, every person should be treated professionally and with the available resources.

Conclusion

Incorporation of the doctors’ effort to prioritize the patient’s treatment according to severity or age with the available resources remains a challenge worldwide. However, a pandemic episode brings an entirely different perception of how preparedness is key to diverse levels of economies. New epidemics require essential planning to manage unpredictable conditions accompanying them. The rationing of healthcare resources remains a problem due to other factors, including infrastructure; hence, it is completely unavoidable. Nevertheless, if specific fundamental ethical values are implemented when rationing, essential medical services can be easily provided to those who deserve them.

References

Aziz, H., & Brandl, F. (2021). Efficient, fair, and incentive-compatible healthcare rationing. In Proceedings of the 22nd ACM Conference on Economics and Computation (pp. 103-104). Web.

Brendbekken, A., Robberstad, B., & Norheim, O. F. (2022). Public participation: healthcare rationing in the newspaper media. BMC health services research, 22(1), 1-14. Web.

Dieteren, C. M., Reckers- Droog, V. T., Schrama, S., Boer, D & Exel, V J. (2021). Viewpoints among experts and the public in the Netherlands on including a lifestyle criterion in the healthcare priority setting. Health Expectations, 25, 333-344. Web.

Fink, S. (2020). The hardest questions doctors may face: Who will be saved? Who won’t. New York Times, 21. Web.

Hauge, A M., Otto, E I., & Wadmann, S. (2022). The sociology of rationing; Towards increased interdisciplinary dialogue- A critical interpretive literature review. Sociology of health and illness, 44, 127-1304. Web.

Srinivas, G., Maanasa, R., Meenakshi, M., Adaikalam, J. M., Seshayyan, S., & Muthuvel, T. (2021). Ethical rationing of healthcare resources during the COVID-19 outbreak. Ethics, Medicine and Public Health, 16, 100633. Web.