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Rationing of Resources: Ethical Issues in Disasters and Epidemic Situations

Published online by Cambridge University Press:  28 June 2012

Janet Y. Lin  and
Lisa Anderson-Shaw
Janet Y. Lin*
Affiliation:
Assistant Professor, Department of Emergency Medicine, College of Medicine, Affiliate Assistant Professor, Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
Lisa Anderson-Shaw
Affiliation:
Director, Clinical Ethics Consult Service, Assistant Clinical Professor, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
*
808 South Wood StreetCME 470Chicago, Illinois 60612USA E-mail: jlin7@uic.edu
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Abstract

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In an epidemic situation or large-scale disaster, medical and human resources may be stretched to the point of exhaustion. Appropriate planning must incorporate plans of action that minimize public health morbidity and mortality while maximizing the appropriate use of medical and human healthcare resources. While the current novel H1N1 influenza has spread throughout the world, the severity of this strain of influenza appears to be relatively less virulent and lethal compared to the 1918 influenza pandemic.However, the presence of this new influenza strain has reignited interest in pandemic planning.

Amongst other necessary resources needed to combat pandemic influenza, a major medical resource concern is the limited number of mechanical ventilators that would be available to be used to treat ill patients. Recent reported cases of avian influenza suggest that mechanical ventilation will be required for the successful recovery of many individuals ill with this strain of virus. However, should the need for ventilators exceed the number of available machines, how will care providers make the difficult ethical decisions as to who should be placed or who should remain on these machines as more influenza patients arrive in need of care?

This paper presents a decision-making model for clinicians that is based upon the bioethical principles of beneficence and justice. The model begins with the basic assumptions of triage and progresses into a useful algorithm based upon utilitarian principles. The model is intended to be used as a guide for clinicians in making decisions about the allocation of scarce resources in a just manner and to serve as an impetus for institutions to create or adapt plans to address resource allocation issues should the need arise.

Keywords

allocationdecision-makingepidemicethicsmechanical ventilationmedical resourcestriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 24 , Issue 3 , June 2009 , pp. 215 - 221
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2009

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