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Published on: September 28, 2022
Promoting racial equity in COVID-19 resource allocation
Lori Bruce1,2,3, Ruth Tallman3,4
1Interdisciplinary Center for Bioethics, Yale University, New Haven, Connecticut, USA Lori.Bruce@yale.edu.
Insights
COVID-19 triage protocols often worsen racial disparities. This paper critiques current methods and proposes a new paradigm to ensure equitable resource allocation for all patients, addressing systemic inequities.
Area of Science:
- Public Health
- Health Equity
- Medical Ethics
Background:
- COVID-19 has strained global health systems, necessitating triage protocols for scarce resource allocation.
- Existing triage methods, relying on numerical morbidity scores, perpetuate racial disparities and health inequities.
- Policy responses have been insufficient to address the complexity of racial bias in triage.
Purpose of the Study:
- To dismantle arguments against addressing racial inequity in COVID-19 triage.
- To highlight concerns with current and proposed triage protocols.
- To propose a new framework for equitable allocation of COVID-19 resources.
Main Methods:
- Critical analysis of existing COVID-19 triage protocols and their ethical implications.
- Examination of policy statements and their translation into practice.
- Review of arguments for and against race-based considerations in triage.
- Development of a novel paradigm for equitable resource allocation.
Main Results:
- Standard triage protocols exacerbate racial disparities in healthcare.
- Race-based exceptions in triage are complex but not insurmountable.
- Existing policies often make exceptions, demonstrating flexibility that can be applied to address racial inequity.
Conclusions:
- A new paradigm is needed to ensure COVID-19 resource allocation is equitable.
- Addressing racial bias in triage is crucial for achieving health justice.
- Flexibility in policy-making should be extended to prioritize patients of color.
Abstract:
Due to COVID-19's strain on health systems across the globe, triage protocols determine how to allocate scarce medical resources with the worthy goal of maximising the number of lives saved. However, due to racial biases and long-standing health inequities, the common method of ranking patients based on impersonal numeric representations of their morbidity is associated with disproportionately pronounced racial disparities. In response, policymakers have issued statements of solidarity. However, translating support into responsive COVID-19 policy is rife with complexity. Triage does not easily lend itself to race-based exceptions. Reordering triage queues based on an individual patient's racial affiliation has been considered but may be divisive and difficult to implement. And while COVID-19 hospital policies may be presented as rigidly focused on saving the most lives, many make exceptions for those deemed worthy by policymakers such as front-line healthcare workers, older physicians, pregnant women and patients with disabilities. These exceptions demonstrate creativity and ingenuity-hallmarks of policymakers' abilities to flexibly respond to urgent societal concerns-which should also be extended to patients of colour. This paper dismantles common arguments against the confrontation of racial inequity within COVID-19 triage protocols, highlights concerns related to existing proposals and proposes a new paradigm to increase equity when allocating scarce COVID-19 resources.
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