Ventilator Allocation Protocols: Sophisticated Bioethics for an Unworkable Strategy.

Area of Science:

• Critical Care Medicine
• Public Health Ethics
• Health Policy

Background:

• Development of crisis standards of care (CSC) for the COVID-19 pandemic involved careful ethical considerations.
• Protocols addressed resource scarcity, prioritization of essential workers, and structural racism.

Purpose of the Study:

• To evaluate the practical implementation and fundamental flaws of existing ventilator allocation protocols.
• To critique the assumption that clinicians select patients for ventilators based on priority categories.

Main Methods:

• Analysis of existing state-level CSC protocols for ventilator allocation.
• Critique based on clinical experience in critical care settings.

Main Results:

• Existing CSC protocols are based on an unrealistic assumption of patient selection by clinicians.
• The proposed ethical frameworks, despite sophistication, are virtually impossible to implement in real-world scenarios.

Conclusions:

• The fundamental approach of current ventilator allocation protocols is flawed.
• Real-world clinical practice diverges significantly from the theoretical models used in CSC development.