Ethical decision making during a healthcare crisis: a resource allocation framework and tool

Area of Science:

• Healthcare ethics
• Public health policy
• Clinical resource management

Background:

• The COVID-19 pandemic has severely strained global healthcare resources, necessitating difficult ethical decisions regarding resource allocation.
• Initial responses, like uniform clinical activity ramp-down, led to inefficiencies and resource waste.
• Existing ethical frameworks for resource allocation required adaptation to address pandemic-specific challenges.

Purpose of the Study:

• To develop a fair and ethical decision-making tool for resource allocation during healthcare crises.
• To create a structured approach for institutions to manage clinical activity during pandemic waves.
• To ensure diverse stakeholder perspectives inform the development of resource allocation strategies.

Main Methods:

• Formation of an interprofessional clinical activity recovery team.
• Integration of institutional objectives with procedural values, ethical principles, and decision-making criteria.
• Application of a modified "accountability for reasonableness" ethical framework.
• Development of a stepwise, semiquantitative ethical decision tool.

Main Results:

• A novel, stepwise, semiquantitative ethical decision tool was developed.
• The tool systematically guides fair and ethically defensible resource allocation decisions.
• The tool is adaptable for use at both institutional and departmental levels.

Conclusions:

• The developed ethical decision tool provides a practical framework for navigating resource scarcity.
• It supports clinical leaders in making fair and ethically sound decisions during public health emergencies like the COVID-19 pandemic.
• This tool promotes a more prudent and ethical approach to managing healthcare resources under pressure.