Too old to save? COVID-19 and age-based allocation of lifesaving medical care

Area of Science:

• Medical Ethics
• Public Health Policy
• Gerontology

Background:

• Older adults (65+) disproportionately suffer severe outcomes and mortality from COVID-19.
• Pandemics necessitate difficult resource allocation decisions, often involving triage.
• Ethical frameworks for resource allocation are challenged during public health emergencies.

Purpose of the Study:

• To critically evaluate ethical arguments for using age-based criteria in pandemic triage.
• To examine both implicit and explicit age-based resource allocation standards.
• To determine the ethical validity of age as a primary factor in life-saving resource distribution during pandemics.

Main Methods:

• Review and analysis of ethical arguments concerning age-based allocation.
• Distinction between standard triage and pandemic-specific triage protocols.
• Assessment of implicit age criteria (e.g., QALYs, DALYs, future life years).
• Examination of explicit age criteria (e.g., fair innings, age equality, priority to the worse off).

Main Results:

• Implicit age-based criteria, such as Quality-Adjusted Life Years (QALYs) and Disability-Adjusted Life Years (DALYs), are ethically problematic.
• Explicit age-based criteria, including fair innings and age equality principles, do not withstand ethical scrutiny.
• No age-based allocation standard, whether implicit or explicit, proves ethically justifiable for scarce life-saving resources.

Conclusions:

• Age-based criteria for allocating scarce life-saving resources during pandemics are ethically indefensible.
• Ethical frameworks must be carefully examined to avoid discriminatory practices in public health emergencies.
• Alternative, non-age-based ethical frameworks should be prioritized for pandemic resource allocation.