It is important to note that ethics play a major role in healthcare since resources determine the overall health and well-being of an individual, groups, and populations. The given assessment will primarily focus on the global health issue of COVID-19 with an emphasis on its global implications and solutions. The policy analysis is based on rationing and triage processes to share the limited resources during the pandemic. Such an approach is based on allocating key and scarce healthcare resources to the most vulnerable patients with the highest risk of complications. It is stated that “triage prioritizes medical utility by sorting and allocating the limited available care to patients based on their disease severity and favoring those whom the critical care intervention would give the highest survival chances” (Basu, 2021, p. 1). In other words, the policy focuses on medical outcomes as the most critical factor when making decisions and prioritizations.
Ethical Resource Allocation Framework
In order to extensively and comprehensively assess the triage policy of COVID-19 used globally, it is vital to define the ethical resource allocation framework as a metric for evaluation. The given assessment will utilize the Center for Disease Control’s (CDC) framework of ethical resource distribution. It states that “critical care allocation during a pandemic emergency should uphold basic biomedical principles through maintenance of procedural justice which requires decision-making that is consistent, impartial, neutral, and nondiscriminatory” (Basu, 2021, p. 1). Thus, resource allocation procedures must not discriminate, favor, or be partial to specific groups of people.
Policy Justification for Resource Allocation
In accordance with the triage and rationing during COVID-19, the resources should be given only to the patients with the most severe symptoms and a high likelihood of death. In addition, people who would be the most likely to survive are additionally favored. For example, if patient A has milder COVID-19 symptoms than patient B, then the latter will be the one who uses a ventilator. Another illustration of triage would be prioritizing patient C, who would be more likely to survive if given the ventilator access, over patient D, who has similarly severe symptoms.
Outcomes Resulting the Policy Allocations
The key result of triage policy is medical outcomes, which means the greatest number of people survive. The core idea is based on focusing on and helping the most vulnerable and at-risk patients. For instance, the limited resources were mostly given to older adults, people with chronic conditions, and the severely ill since they have the highest mortality rates (Emanuel et al., 2020). Death from severe symptoms acts as a prime target under triage, which is prevented by considering the likelihood of survival as well.
Tradeoffs
Although the triage policy is mostly accepted to be fair and just, there are some tradeoffs to such an approach. One of the main problems with it is the fact that people with disabilities are at risk of discrimination. It is stated that ableism takes place in real practice, where the group is viewed as less likely to survive if given access to limited resources, which creates discrimination (Andrews et al., 2021). In addition, the healthcare system within the triage framework emphasizes COVID-19 itself, which diminishes the attention and care provided for non-COVID-19 disabilities and health issues.
Fairness of Policy
Overall, the policy was fair for the most part because it blinded itself toward illnesses unrelated to COVID-19. Although it unintentionally resulted in discrimination against people with disabilities, the latter was mainly a side effect rather than intentional malevolence. Despite the fact that disabilities are important, the mortality rates and deaths outweigh the decision-making process as the most negative outcome. The justification can be found in the core principles of medicine, which include beneficence (do good) and non-maleficence (do no harm) (Mason et al., 2020). Triage prevents the ultimate harm, which is death, and it emphasizes beneficence. In addition, it seeks to minimize harm by rejecting access to resources that would be damaged by COVID-19 the least.
Comparison with Ethical Resource Allocation
The ethical resource allocation framework criteria revolve around consistency, impartiality, neutrality, and nondiscrimination. Triage differs from the latter by abandoning neutrality and impartiality by engaging in prioritization and rationing. Under it, the healthcare system does not view a person with mild COVID-19 symptoms and a patient with severe symptoms equally. Similarly, triage favors an individual with a 55% chance of survival over a 45% chance of survival (Reid, 2020). In other words, it actively engages in ranking and evaluating the core metrics when making decisions about limited resource allocation decisions.
Outcomes from an Ethical Resource Allocation Framework
If the policy used the Ethical Resource Allocation Framework to determine resource allocation, it would not differentiate between vulnerable groups and people with mild symptoms. It would most likely operate on a first-come-first-serve basis, which would mean that the medical outcomes would be worse. The assessment reveals that there is a justification for the triage and ration resources in favor of high-risk groups, such as the elderly and people with chronic conditions. The reason is that death is the most undesirable outcome, which is why some unintentional pitfalls of triage are acceptable and negligible.
The Tradeoff in an Ethical Framework
It should be noted that the key tradeoff would be significantly higher mortality rates from COVID-19 and overflown hospitals by people who would not have died anyway. High COVID-19 death rates would be the prime result since medical outcomes are no longer the priority. It might have had better adherence to the nondiscrimination side effect of the core framework, but, ultimately, triage is a superior and more ethical alternative.
References
Andrews, E. E., Ayers, K. B., Brown, K. S., Dunn, D. S., & Pilarski, C. R. (2021). No body is expendable: Medical rationing and disability justice during the COVID-19 pandemic. The American Psychologist, 76(3), 451-461. Web.
Basu, S. (2021). Approaches to critical care resource allocation and triage during the COVID-19 pandemic: An examination from a developing world perspective.Journal of Medical Ethics and History of Medicine, 14(5), 1-11. Web.
Emanuel, E. J., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A., Zhang, C., Boyle, C., Smith, M., & Phillips, J. P. (2020). Fair allocation of scarce medical resources in the time of Covid-19.The New England Journal of Medicine, 382(21), 2049-2055. Web.
Mason, D. J., Perez, A., McLemore, M. R., & Dickson, E. (2020). Policy & politics in nursing and health care (8th ed.). Elsevier.
Reid, L. (2020). Triage of critical care resources in COVID-19: A stronger role for justice.Journal of Medical Ethics, 46, 526-530. Web.