When Demand Outstrips Supply: A Christian View of the Ethics of Healthcare Resource Allocation During the COVID-19 Pandemic
The coronavirus (COVID-19) pandemic presents the greatest challenge to global healthcare systems in living memory. This article deals with the ethics of rationing the supply of scarce healthcare resources, such as ventilators, during periods of high demand, such as the current pandemic. Existing ethical guidelines and commentaries are cited and critiqued from a Christian ethics viewpoint.
Edwards M. Triage. Lancet. 2009;373(9674):1515. https://doi.org/10.1016/S0140-6736(09)60843-6.
Ives J. Coronavirus may force UK doctors to decide who they’ll save [Internet]. The Guardian. 2020 Mar 14. Available from: https://www.theguardian.com/commentisfree/2020/mar/14/coronavirus-outbreak-older-people-doctors-treatment-ethics.
COVID-19 — ethical issues. A guidance note [Internet]. British Medical Association. 2020 Apr 1. Available from: https://www.bma.org.uk/media/2226/bma-covid-19-ethics-guidance.pdf.
COVID-19 rapid guideline: critical care in adults [Internet]. National Institute for Health and Care Excellence. 2020 Mar 20. Available from: https://www.nice.org.uk/guidance/ng159.
Ethical dimensions of COVID-19 for frontline staff [Internet]. Royal College of Physicians. 2020 Apr 2. Available from: https://www.rcplondon.ac.uk/news/ethical-guidance-published-frontline-staff-dealing-pandemic.
Beauchamp TL, Childress JF. Principles of biomedical ethics. 5th rev. ed. New York: Oxford University Press; 2001.
Treatment and care towards the end of life: good practice in decision making [Internet]. General Medical Council. 2010 Jul 1. Available from: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/treatment-and-care-towards-the-end-of-life/principles.
Haslam J. CMF File 62: Withholding and withdrawing medical treatment [Internet]. Christian Medical Fellowship. 2017. Available from: https://admin.cmf.org.uk/pdf/cmffiles/62_withholding_medical_treatment.pdf.
Bentham J. An introduction to the principles of morals and legislation (1789). Garden City, NJ: Doubleday; 1961.
Response from CMF to NICE on their draft guidelines on social value judgements [Internet]. Christian Medical Fellowship. 2005 Jun 30. Available from: https://www.cmf.org.uk/advocacy/submissions/?id=38.
Stevens D. The ethical approach to limited resources. In: A Christian healthcare worker’s response to COVID-19 [Internet]. Medical Missions. 2020. Available from: https://www.medicalmissions.com/coronavirus.
White DB, Lo B. A framework for rationing ventilators and critical care beds during the COVID-19 pandemic. JAMA [Internet]. 2020 Mar 27. https://doi.org/10.1001/jama.2020.5046.
Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair allocation of scarce medical resources in the time of Covid-19. NEJM [Internet]. 2020 Mar 23. https://doi.org/10.1056/nejmsb2005114.
Coulson-Smith P, Lucassen A. Clinical ethics guidance during the COVID-19 pandemic. Paper presented at: University Hospital Southampton Clinical Ethics Committee. 2020 Mar 30; Southampton, UK.
Report on 775 patients critically ill with COVID-19 [Internet]. Intensive Care National Audit & Research Centre. 2020 Mar 27. Available from: https://www.icnarc.org/About/Latest-News/2020/03/27/Report-On-775-Patients-Critically-Ill-With-Covid-19.
Cocker F, Joss N. Compassion fatigue among healthcare, emergency and community service workers: a systematic review. Int J Environ Res Public Health. 2016;13(6):618. https://doi.org/10.3390/ijerph13060618.
Peppiatt P. Too tired to care. In: Spotlight [Internet]. Christian Medical Fellowship. 2018 Spring. Available from: https://www.cmf.org.uk/resources/publications/content/?context=article&id=26779.
UK Government [Internet]. The NHS constitution for England [updated 2015 Oct 14; cited 2020 Apr 3]. Available from: https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england.
UK Government [Internet]. Pandemic flu: ethical framework [cited 2020 Apr 3]. 2013 Feb 20 [updated 2017 Nov 24]. Available from: https://www.gov.uk/guidance/pandemic-flu#ethical-framework.
Intensive Care Society. Legal and Ethical Advisory Group (LEAG) statement: statement on legal liabilities of clinicians as individuals during coronavirus pandemic [Internet]. 2020 Mar 31 [cited 2020 Apr 3]. Available from: http://ics.informz.net/z/cjUucD9taT03ODY4NzM0JnA9MSZ1PTgwOTM0MDc4OCZsaT02NDQwMzc3OA/index.html.
Truog RD, et al. The toughest triage — allocating ventilators in a pandemic. NEJM [Internet]. 2020 Mar 23. https://doi.org/10.1056/nejmp2005689.
Christian Journal for Global Health applies the Creative Commons Attribution License to all articles that we publish. Under this license, authors retain ownership of copyright for their articles or they can transfer copyright to their institution, but authors allow anyone without permission to copy, distribute, transmit, and/or adapt articles, even for commercial purposes so long as the original authors and Christian Journal for Global Health are appropriately cited.
This work is licensed under a Creative Commons Attribution 4.0 International License.