Introduction
Clinical ethics, a crucial component of healthcare practice, is deeply rooted in guiding practitioners through the maze of ethical quandaries often encountered in their line of work. This pragmatic ethical approach is an invaluable tool, aiding health professionals in not only identifying but also analysing and resolving the myriad ethical issues that routinely arise in clinical practice.
The COVID-19 pandemic has thrown these ethical issues into sharp relief. This global health crisis has sparked a multitude of ethical concerns related to clinical practice, many of which challenge the very foundations of healthcare ethics. Among these, we find issues of justice, the respect for patient autonomy, non-maleficence, and beneficence standing at the forefront of clinical ethical debates.
Justice, in the realm of healthcare, concerns the equitable allocation of resources, especially when they are scarce or strained, as has been the case during the COVID-19 pandemic. Respect for autonomy underscores the importance of patient-centred decision-making, a concept often muddled when triage decisions are guided by wider public health goals rather than individual patient interests.
Non-maleficence, the principle of “do no harm”, and beneficence, the commitment to promoting good, are both put to the test in the context of COVID-19. How can we balance the urgency of treating critically ill patients against the potential risk of overburdening healthcare systems and depleting resources for others?
Triage, the process of determining the priority of patients’ treatments based on the severity of their condition or their likelihood of recovery with or without treatment, has become a central strategy in managing the COVID-19 crisis. Triage decisions during this pandemic have often involved the tough choice of selecting which patients are eligible for an intensive care bed when resources are constrained.
The ethics of triage in the face of COVID-19 is a complex subject that goes beyond clinical decisions and is deeply intertwined with societal values, human rights, and public trust. It raises profound questions about the value we place on individual lives, our collective responsibility, and our commitment to the principles of fairness and equality.
Navigating these ethical complexities requires both a thorough understanding of the evolving science of COVID-19 and a nuanced application of ethical principles in making difficult decisions.
Below you will find links to literature that explores the intersections of clinical ethics and triage in greater detail. These resources offer a deeper dive into these profound and pressing ethical considerations, providing both professional insights and practical guidance for those grappling with these challenges in the COVID-19 era.
Clinical Ethics
Wilkinson D, “Frailty Triage: Is Rationing Intensive Medical Treatment on the Grounds of Frailty Ethical?”, The American Journal of Bioethics, 2021.
Dao B et al., “Ethical Factors determining ECMO allocation during the COVID-19 pandemic”, BMC Medical Ethics (22), June 2021.
Rorvig L, Williams B, “Providing Ethical and Humane Care to Hospitalized, Incarcerated Patients With COVID-19”, American Journal of Hospice and Palliative Medicine, February 10, 2021.
Murano MC, Maglio M, Foureur N, “Clinical Ethics Consultation during the First COVID-19 Lock Down in France: The “Commitment Model”: Balancing General Questions and Individual Cases.”, The Journal of Clinical Ethics, 01 January 2021.
Bardon E, “An ethical approach to considering family presence during COVID-19”, Healthcare Management Forum, December 23, 2020.
Elsner AM, “After COVID-19: The Way We Die from Now On”, Cambridge Quarterly of Healthcare Ethics, December 20, 2020.
Reynolds et al., “Against Personal Ventilator Reallocation”, Cambridge Quarterly of Healthcare Ethics, October 30, 2020.
Silvia Camporesi and Maurizio Mori, “Ethicists, Doctors and Triage Decisions: Who Should Decide? And on What Basis?” Journal of Medical Ethics, July 10, 2020.
Lucia Craxì et al., “Rationing in a Pandemic: Lessons from Italy,” Asian Bioethics Review, June 16, 2020.
Lynette Reid, “Triage of Critical Care Resources in COVID-19: A Stronger Role for Justice,” Journal of Medical Ethics, June 16, 2020.
Benjamin Herreros, “Triage During the COVID-19 Epidemic in Spain: Better and Worse Ethical Arguments,” Journal of Medical Ethics, May 18, 2020.
Andrew Peterson, Emily A. Largent, and Jason Karlawish, “Ethics of Reallocating Ventilators in the COVID-19 Pandemic,” BMJ, May 12, 2020.
Kathleen Liddell et al., “Who Gets the Ventilator? Important Legal Rights in a Pandemic,” Journal of Medical Ethics, May 11, 2020.
Lalit Kumar Radha Krishna et al., “The Role of Palliative Medicine in ICU Bed Allocation in COVID-19: A Joint Position Statement of the Singapore Hospice Council and the Chapter of Palliative Medicine Physicians,” Asian Bioethics Review, June 1, 2020.
Susan Dorr Goold, “The COVID-19 Pandemic: Critical Care Allocated in Extremis,” The American Journal of Bioethics, April 24, 2020.
Laurence B. McCullough, “In Response to COVID-19 Pandemic Physicians Already Know What to Do,” The American Journal of Bioethics, April 23, 2020.
Douglas B. White and Bernard Lo, “A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic,” JAMA, March 27, 2020.
Douglas B. White et al., “Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions,” Annals of Internal Medicine, January 20, 2009.
Armand H. Matheny Antommaria et al., “Ethical Issues in Pediatric Emergency Mass Critical Care,” Pediatric Critical Care Medicine 12 (2011): S163-S168.
Triage
Vinay R et al., “Ethics of ICU triage during COVID-19”, British Medical Bulletin, June, 2021.
Sarmento JT et al., “What is common and what is different: recommendations from European scientific societites for triage in the first outbreak of COVID-19”, Journal of Medical Ethics, May 12, 2021.
Barilan YM, “Allocation of Respirators in the Coronavirus Crisis in Israel: An Ethical Analysis and a Scheme for Triage”, The Israel Medical Association Journal, May, 2021.
Kuylen et al., “Should age matter in COVID-19 triage? A deliberative study”, Journal of Medical Ethics, March 9, 2021.
Tham J, Melahn L, Baggot M, “Withdrawing critical care from patients in a triage situation”, Medicine, Health Care and Philosophy (24), January 2021.
Booke H and Booke M, “Medical Triage During the COVID-19 Pandemic: A Medical and Ethical Burden”, The Journal of Clinical Ethics, January 01, 2021.
Ehni et al., “Saving the most lives – A comparison of European triage guidelines in the context of the COVID-19 pandemic”, bioethics, December 16, 2020.
Keymanthri Moodley et al., “What Could ‘Fair Allocation’ During the COVID-19 Crisis Possibly Mean in Sub-Saharan Africa?” Hastings Center Report, June 29, 2020.
Hans Flaatten et al., “The Good, the Bad and the Ugly: Pandemic Priority Decisions and Triage,” Journal of Medical Ethics, June 10, 2020.
Samuel Gorovitz, “Ventilators, Guidelines, Judgment, and Trust,” Hastings Center Report, June 29, 2020.
J.A. Singh and K. Moodley, “Critical Care Triaging in the Shadow of COVID-19: Ethics Considerations,” South African Medical Journal, April 16, 2020.
James Tabery et al. “Ethics of Triage in the Event of an Influenza Pandemic,” Disaster Medicine and Public Health Preparedness 2 (2008): 114-118.
Michael D. Christian et al., “Development of a Triage Protocol for Critical Care During an Influenza Pandemic,” CMAJ 175 (2006): 1377-81.
Robert D. Truog, Christine Mitchell, and George Q. Daley, “The Toughest Triage – Allocating Ventilators in a Pandemic,” New England Journal of Medicine, March 23, 2020.
Dominic Wilkinson, “ICU Triage in an Impending Crisis: Uncertainty, Pre-Emption, and Preparation,” Journal of Medical Ethics, April 1, 2020.
Mildred Z. Solomon, Matthew K. Wynia, and Lawrence O. Gostin, “COVID-19 Crisis Triage – Optimizing Health Outcomes and Disability Rights,” The New England Journal of Medicine, May 19, 2020.
Priority Setting
Priority Setting, a central pillar of health policy and decision-making, concerns the decisions made about the allocation of resources amidst the competing demands of different services, distinct patient groups, or various elements of care. These decisions are far from easy, as they force us to confront the challenging question: how are we to rank health services or patient groups against one another when each is of undeniable value and import?
Priority setting can transpire across various levels, each bringing with it a unique set of complexities and considerations. At the population level, decisions need to be made about which public health interventions to prioritise and how to equitably distribute health resources within the community. At the organisational level, health institutions must grapple with deciding which services to provide, and how to balance the demand for high-cost treatments against the need for basic care. Meanwhile, at the patient level, clinicians are often faced with the task of prioritising patients’ care needs, especially when resources are limited.
The criteria and methods employed for priority setting can differ significantly, with each having profound ethical implications. For instance, some systems might prioritise cost-effectiveness, focusing resources where they can yield the most health benefit per unit of cost. Other systems might prioritise according to age, channeling resources towards particular age groups deemed to be of higher or lower priority. Yet others might prioritise based on need, allocating resources to those who require them the most.
Beyond these criteria, other relevant areas come into play in the arena of priority setting. This could include the consideration of social value judgments, the pursuit of health equity, the management of conflicts of interest, and the mitigation of unfair disparities in health.
Priority setting, as an integral part of healthcare decision-making, bears significant weight on the accessibility, quality, and equity of health services. It is, therefore, paramount to approach this task with a deep sense of responsibility, grounded in ethical principles, and informed by the best available evidence.
Below you will find links to various literature pieces that delve deeper into the multifaceted and complex world of priority setting in healthcare. These resources aim to shed light on the intricate dynamics, ethical considerations, and practical applications of priority setting in different contexts and levels of health care delivery.
Criteria and Methods for Priority Setting
Cylus et al., “Who should be vaccinated first? Comparing vaccine prioritization strategies in Israel and European countries using the Covid-19 Health System Response Monitor”, Israel Journal of Health Policy Research, February 19, 2021.
Norheim et al., “Difficult trade-offs in response to COVID-19: the case for open and inclusive decision making”, Nature Medicine, December 18, 2020.
Harris J, “Combatting Covid-19. Or, “All persons are equal but some persons are more equal than others?”, Cambridge Quarterly of Healthcare Ethics, November 2020.
Anita Ho and Iulia Dascalu, “Global Disparity and Solidarity in a Pandemic,” Hastings Center Report, June 29, 2020.
Chiara Mannelli, “Whose Life to Save? Scarce Resources Allocation in the COVID-19 Outbreak,” Journal of Medical Ethics, April 9, 2020.
Julian Savulescu, James Cameron, and Dominic Wilkinson, “Equality or Utility? Ethics and Law of Rationing Ventilators,” British Journal of Anaesthesia, April 20, 2020.
Amy Solnica, Leonid Barski, and Alan Jotkowitz, “Allocation of Scarce Resources During the COVID-19 Pandemic: A Jewish Ethical Perspective,” Journal of Medical Ethics, April 10, 2020.
Marcel Verweij, “Moral Principles for Allocating Scarce Medical Resources in an Influenza Pandemic,” Journal of Bioethical Inquiry 6 (2009): 159-169.
Thomas J. Bollyky, Lawrence O. Gostin, and Margaret A. Hamburg, “The Equitable Distribution of COVID-19 Therapeutics and Vaccines,” JAMA, May 7, 2020.
Govind Persad, Alan Wertheimer, and Ezekiel J. Emanuel, “Principles for Allocation of Scarce Medical Interventions,” The Lancet, January 31, 2009
Jane H. Williams and Angus Dawson, “Prioritising Access to Pandemic Influenza Vaccine: A Review of the Ethics Literature,” BMC Medical Ethics, May 14, 2020.
Govind Persad, Alan Wertheimer, and Ezekiel J. Emanuel, “Principles for Allocation of Scarce Medical Interventions,” The Lancet, January 31, 2009
Catherine L. Auriemma et al., “Eliminating Categorical Exclusion Criteria in Crisis Standards of Care Frameworks,” The American Journal of Bioethics, May 18, 2020.
David Ian Jeffrey, “Relational Ethical Approaches to the COVID-19 Pandemic,” Journal of Medical Ethics, June 10, 2020.
Amy L. McGuire et al., “Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force,” The American Journal of Bioethics, June 8, 2020.
Vicki Xafis et al., “The Perfect Moral Storm: Diverse Ethical Considerations in the COVID-19 Pandemic,” Asian Bioethics Review, May 28, 2020.
Angela Ballantyne et al., “Revisiting the Equity Debate in COVID-19: ICU is no Panacea,” Journal of Medical Ethics, June 22, 2020.
Denise M. Dudzinski, Benjamin Y. Hoisington, and Crystal E. Brown, “Ethics Lessons from Seattle’s Early Experience with COVID-19,” The American Journal of Bioethics, June 18, 2020.
Leniza de Castro-Hamoy and Leonardo D. de Castro, “Age Matters but it Should Not be Used to Discriminate Against the Elderly in Allocating Scarce Resources in the Context of COVID-19,” Asian Bioethics Review, June 16, 2020.
Nancy S. Jecker, Aaron G. Wightman, and Douglas S. Diekema, “Prioritizing Frontline Workers During the COVID-19 Pandemic,” The American Journal of Bioethics, May 13, 2020.
Barbara Pfeffer Billauer, “The Bioethics of COVID19 Care in the Elderly: Ventilation and Vaccines,” Available at SSRN, July 9, 2020.
Alberto Giubilini, Julian Savulescu, and Dominic Wilkinson, “COVID-19 Vaccine: Vaccinate the Young to Protect the Old?” Journal of Law and the Biosciences, June 26, 2020.
Leslie Wolf and Wendy Hensel, “Valuing Lives: Allocating Scarce Medical Resources During a Public Health Emergency and the Americans with Disabilities Act,” PLoS Currents 3 (2011).
Kristy Buccieri and Stephen Gaetz, “Ethical Vaccine Distribution Planning for Pandemic Influenza: Prioritizing Homeless and Hard-to-Reach Populations,” Public Health Ethics 6 (2013): 185-196.
Marlyse F. Haward, “Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis?” The American Journal of Bioethics, May 13, 2020.
Management and Priority Setting
Binagwaho A, Mathewos K, Davis S, Time for the ethical management of COVID-19 vaccines, The Lancet, August 2021.
Hooper J. et al., “Addressing the psychological impact of COVID-19 on healthcare workers: learning from a systematic review of early interventions for frontline responders”, BMJ Open, May 2021.
Bose et al., “The Cost of Quarantine – Projecting the Financial Impact of Canceled Elective Surgery on the Nation’s Hospitals”, Annals of Surgery, May 2021.
Baker et al., “Case Management on the Front Lines of COVID-19: The Importance of the Individualized Care Plan Across Care Settings”, Professional Case Management, March 01, 2021.
Kamar et al., “Challenge of forecasting demand of medical resources and supplies during a pandemic: A comparative evaluation of three surge calculators for COVID-19”, Epidemiology & Infection, February 03, 2021.
Maduke et al., “Are We Coping Well with COVID-19? A Study on Its Psycho-Social Impact on Front-line Healthcare Workers”, Missouri Medicine, January 2021.
Udo Schuklenk, “COVID19: Why Justice and Transparency in Hospital Triage Policies are Paramount,” Bioethics, April 1, 2020
Lisa Rosenbaum, “Facing COVID-19 in Italy – Ethics, Logistics, and Therapeutics on the Epidemic’s Front Line,” NEJM, March 18, 2020.
Samuel R. Bagenstos, “May Hospitals Withhold Ventilators from COVID-19 Patients with Pre-Existing Disabilities? Notes on the Law and Ethics of Disability-Based Medical Rationing,” Yale Law Journal Forum, March 27, 2020.
Donna Levin et al., “Altered Standards of Care During an Influenza Pandemic: Identifying Ethical, Legal, and Practical Principles to Guide Decision Making,” Disaster Medicine and Public Health Preparedness 3 (2009): S132-S140.
I. Glenn Cohen, Andrew M. Crespo, and Douglas B. White, “Potential Legal Liability for Withdrawing or Withholding Ventilators During COVID-19: Assessing the Risks and Identifying Needed Reforms,” JAMA, April 1, 2020.
Nuffield Council on Bioethics, Policy Briefing: Key Challenges for Ensuring Fair and Equitable Access to COVID-19 Vaccines and Treatments, May 29, 2020.
Population Level Priority Setting
Agorastos et al., “The need for holistic, longitudinal and comparable, real-time assessment of the emotional, behavioral and societal impact of the COVID-19 pandemic across nations”, Psychiatriki, March 08, 2021.
Itamar Megiddo, “Fairer Financing of Vaccines in a World Living with COVID-19,” BMJ Global Health, July 15, 2020.
R. Thomas Day et al., “From Ventilators to Vaccines: Reframing the Ethics of Resource Allocation,” Bioethics.net, June 11, 2020.
Sridhar Venkatapuram, “How Should We Allocate Health and Social Resources During a Pandemic?” in Vulnerable: The Law, Policy, and Ethics of COVID-19, edited by Colleen Flood et al., Ottawa: University of Ottawa Press, July 14, 2020.
Maxwell Smith and Ross Upshur, “Pandemic Disease, Public Health, and Ethics,” in The Oxford Handbook of Public Health Ethics, edited by Anna C. Mastroianni, Jeffrey P. Kahn, and Nancy E. Kass (New York: Oxford University Press, 2019).
Alison K. Thompson et al. “Pandemic Influenza Preparedness: An Ethical Framework to Guide Decision-making,” BMC Medical Ethics 7 (2006):1-11.
University of Toronto Joint Centre for Bioethics, Stand on Guard for Thee: Ethical Considerations in Preparedness Planning for Pandemic Influenza, November 2005.
Scott Y. H. Kim and Christine Grady, “Ethics in the Time of COVID: What Remains the Same and What is Different,” Neurology, April 6, 2020.
Evidence Based Priority Setting
Idilbi N, Abojabel H, Werner P, “Examining hospital staff members’ preferences for allocating a ventilator to a COVID-19 patient with and without Alzheimer’s disease”, Geriatric Nursing, August 2021.
Asghari F, Parsapour A, Gooshki E, “Priority Setting of Ventilators in the COVID-19 Pandemic from the Public’s Perspective”, AJOB Empirical Bioethics, April 2021.
Zeneli A. et al., “Identifying ethical values for guiding triage decisions during the COVID-19 pandemic: an Italian ethical committee perspective using Delphi methodology”, BMJ Open, May, 2021.
Gijsbers M. et al., “Public Preferences in Priority Setting when Admitting Patients to the ICU During the COVID-19 Crisis: A Pilot Study”, The Patient – Patient-Centered Outcomes Research, March 22, 2021.
Pinho M. “Public preferences for allocating absolute scarce critical healthcare resources during the COVID-19 pandemic”, Journal of Health Organization and Management, May 25, 2021.
Bruno et al., “Incorporating Stakeholder Perspectives on Scarce Resource Allocation: Lessons Learned from Policymaking in a Time of Crisis”, Cambridge Quarterly of Healthcare Ethics, March 25, 2021.
Street A.E. et al., “Who Gets the Last Bed? A Discrete-Choice Experiment Examining General Population Preferences for Intensive Care Bed Prioritization in a Pandemic”, Medical Decision Making, March 4, 2021.
Tendal et al., “Weekly updates of national living evidence-based guidelines: methods for the Australian living guidelines for care of people with COVID-19”, Journal of Clinical Epidemiology, March 2021.
Lynch et al., “Ethical Inclusion of Health Care Workers in Covid-19 Research”, Ethics & Human Research, February 09, 2021.
Fallucchi et al., “Fair allocation of scarce medical resources in the time of COVID-19: what do people think?”, Journal of Medical Ethics, January 2021.
E. Lee Daugherty Biddison et al., “Scarce Resource Allocation During Disasters: A Mixed-Method Community Engagement Study,” CHEST 153 (2018): 187-195.
Pius Krütli et al., “How to Fairly Allocate Scarce Medical Resources: Ethical Argumentation under Scrutiny by Health Professionals and Lay People,” PLoS One 11 (2016): 1-18.
Monica Schoch-Spana et al., “Influence of Community and Culture in the Ethical Allocation of Scarce Medical Resources in a Pandemic Situation: Deliberative Democracy Study,” Journal of Participatory Medicine 12 (2020): 1-14.
Govind Persad, “Why Disability Law Permits Evidence-Based Triage in a Pandemic,” Yale Law Journal Forum 130 (2020).
Jeremy R. Garrett et al., “Our Next Pandemic Ethics Challenge? Allocating ‘Normal’ Health Care Services,” Hastings Center Report, June 29, 2020.
Meredith Li-Vollmer, “Health Care Decisions in Disasters: Engaging the Public on Medical Service Prioritization During a Severe Influenza Pandemic,” Journal of Participatory Medicine, December 14, 2010.
Seattle and King County Department of Health, Public Engagement Project on Medical Service Prioritization During an Influenza Pandemic, September 29, 2009.
Gina M. Piscitello et al., “Variation in Ventilator Allocation Guidelines by US State During the Coronavirus Disease 2019,” JAMA, June 19, 2020.
Armand H. Matheny Antommaria et al., “Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated with Members of the Association of Bioethics Program Directors,” Annals of Internal Medicine, April 24, 2020.
Vahid Ghanbari et al., “Ethical Prioritization of Patients During Disaster Triage: A Systematic Review of Current Evidence,” International Emergency Nursing 43 (2019): 126-132.
E.Lee Daugherty Biddison et al., “Too Many Patients…A Framework to Guide Statewide Allocation of Scarce Mechanical Ventilation During Disasters,” CHEST 155 (2019): 848-854.
M.D. Christian et al., “Triage: Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement,” CHEST 146 (2014): e61S-74S.
Distributive Justice
Strodel et al., “COVID-19 vaccine prioritization of incarcerated people relative to other vulnerable groups: An analysis of state plans”, Plos One, June 15, 2021.
Schmidt et al., “Equitable allocation of COVID-19 vaccines in the United States”, Nature Medicine, May 2021.
Iqbal H. et al., “A systematic review to identify research priority setting in Black and minority ethnic health and evaluate their processes”, Plos One, May 28, 2021.
Mazereel V. et al., “COVID-19 vaccination for people with severe mental illness: why, what, and how?”, Lancet Psychiatry, May, 2021.
Modi M. et al., “Equity in coronavirus disease 2019 vaccine development and deployment”, American Journal of Obstretrics and Gynecology, May, 2021.
Aleligne et al., “Racial disparities in Coronavirus Disease 2019 (COVID-19) outcomes”, Current Opinion in Cardiology, May 01, 2021.
González-Rábago et al.,“Social Inequalities in Health Determinants in Spanish Children during the COVID-19 Lockwdown”, International Journal of Environmental Research and Public Health, April 13, 2021.
Hooper et al., “No Populations Left Behind: Vaccine Hesitancy and Equitable Diffusion of Effective COVID-19 Vaccines”, Journal of General Internal Medicine, March 2021.
Choi E.M. “COVID-19 vaccines for low- and middle-income countries”, Tropical Medicine & Hygiene, March 18, 2021.
Ryan M. Antiel et al., “Should Pediatric Patients Be Prioritized When Rationing Life-Saving Treatments During the COVID-19 Pandemic?” Pediatrics, July, 2020.
Panagis Galiastsatos et al., “Health Equity and Distributive Justice Considerations in Critical Care Resource Allocation,” The Lancet Respiratory Medicine, June 22, 2020.
Michelle M. Mello, Govind Persad, and Douglas B. White, “Respecting Disability Rights – Toward Improved Crisis Standards of Care,” The New England Journal of Medicine, May 19, 2020.
Julian Savulescu, Ingmar Perrson, and Dominic Wilkinson, “Utilitarianism and the Pandemic,” Bioethics, May 20, 2020.
Ezekiel J. Emanuel et al., “Fair Allocation of Scarce Medical Resources in the Time of Covid-19,” New England Journal of Medicine, March 23, 2020.
Jeffrey Kirby, “Enhancing the Fairness of Pandemic Critical Care Triage,” Journal of Medical Ethics 36 (2010): 758-761.
Jason W. Nickerson and Matthew Herder, “COVID-19 Vaccines as Global Public Goods,” in Vulnerable: The Law, Policy, and Ethics of COVID-19, edited by Colleen Flood et al., Ottawa: University of Ottawa Press, July 14, 2020.
Thoai Ngo, “We Need a Pro-Poor and Pro-Black Response to COVID-19,” Think Global Health, June 10, 2020.
Harald Schmidt, “Vaccine Rationing and the Urgency of Social Justice in the COVID-19 Response,” Hastings Center Report, May 28, 2020.
Yangzi Liu, Sanjana Salwi, and Brian Drolet, “Multivalue Ethical Framework for Fair Global Allocation of a COVID-19 Vaccine,” Journal of Medical Ethics, June 12, 2020.
Ubaka Ogbogu and Lorian Hardcastle, “Bioethics and Practical Justice in the Post-COVID-19 Era,” Developing World Bioethics, July 30, 2020.
Diego S. Silva et al., “Contextualizing Ethics: Ventilators, H1N1 and Marginalized Populations,” Healthcare Quarterly 13 (2010): 32-36.
Deborah Hellman and Kate Nicholson, “Rationing and Disability in a State of Crisis,” Virginia Public Law and Legal Theory Research Paper No. 2020-33, April 6, 2020.
Thomas A. Bledsoe et al., “Universal Do-Not-Resuscitate Orders, Social Worth, and Life-Years: Opposing Discriminatory Approaches to the Allocation of Resources During the COVID-19 Pandemic and Other Health System Catastrophes,” Annals of Internal Medicine, April 24, 2020.
Matthew M. Kavanagh et al., “Access to Lifesaving Medical Resources for African Countries: COVID-19 Testing and Response, Ethics, and Politics,” The Lancet, May 7, 2020.
Thomas J. Bollyky, Lawrence O. Gostin, and Margaret A. Hamburg, “The Equitable Distribution of COVID-19 Therapeutics and Vaccines,” JAMA, May 7, 2020.
Richard Huxtable, “COVID-19: Where is the National Ethical Guidance?” BMC Medical Ethics 21 (2020), May 1, 2020.
James G. Hodge, Jr., “Revisiting Legal Foundations of Crisis Standards of Care,” The Journal of Law, Medicine, and Ethics, April 28, 2020.
Emily Cleveland Manchanda et al., “Inequity in Crisis Standards of Care,” The New England Journal of Medicine, May 13, 2020.
Laura Guidry-Grimes et al., “Disability Rights as a Necessary Framework for Crisis Standards of Care and the Future of Health Care,” Hastings Center Report, June 29, 2020.
Fair and Legitimate Process
David Wasserman, Govind Persad, and Joseph Millum, “Setting Priorities Fairly in Response to COVID-19: Identifying Overlapping Consensus and Reasonable Disagreement,” Journal of Law and the Biosciences, June 26, 2020.
Douglas B. White and Derek C. Angus, “A Proposed Lottery System to Allocate Scarce COVID-19 Medications: Promoting Fairness and Generating Knowledge,” JAMA, June 24, 2020.
Diego S. Silva, “Ventilators-by-Lottery: The Least Unjust Form of Allocation in the COVID-19 Pandemic,” CHEST, May 12, 2020.
Daniel Patrone and David Resnik, “Pandemic Ventilator Rationing and Appeals Process,” Health Care Analysis 19 (2011): 165-179.
Lawrence O. Gostin, “Medical Countermeasures for Pandemic Influenza: Ethics and the Law,” JAMA 295 (2006): 554-556.
Lawrence O. Gostin, Eric A. Friedman, and Sarah A. Wetter, “Responding to COVID-19: How to Navigate a Public Health Emergency Legally and Ethically,” Hastings Center Report (March-April 2020).