An Innovation Ethics Framework for Safe and Equitable Contingency Planning

AbstractThe contingency phase is a transition period between usual healthcare delivery and the activation of formalized rationing protocols under crisis standards of care. The contingency phase is defined by two simultaneous goals: avert or forestall critical scarcity of healthcare resources, and provide patient-centered care that is functionally equivalent to usual care when dynamic changes to healthcare operations are necessary to prevent hospital surge overload. Contingency measures modify the allocation of hospital space, staff, and supplies in service of these two goals. Although functionally equivalent care is theoretically possible, hospitals often cannot know a priori which alterations to space, staff, or supplies will lead to downstream effects on patient outcomes, raising ethical questions about how hospitals should institute equitable contingency measures when safety and efficacy data is limited. The current ethics literature has not sufficiently addressed these questions.