Evolving Crisis Standards of Care and Ongoing Lessons from COVID-19 Proceedings of a Workshop Series (2022) / Chapter Skim
Currently Skimming:
5 Legal, Ethical, and Equity Considerations for Crisis Standards of Care
5 Legal, Ethical, and Equity Considerations for Crisis Standards of Care
Pages 47-56
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 47... ...
Structured remarks from speakers are followed by a panel discussion and reflections on a way forward in these domains with the ongoing lessons gleaned from the COVID-19 pandemic. LIABILITY PROTECTIONS: ISSUES AROUND MAKING TRIAGE DECISIONS James Hodge, professor and director of the Center for Public Health Law and Policy at Arizona State University, began by restating IOM's original definition of CSC as a substantial change in usual health care operations and level of care because of a catastrophic disaster.
|
From page 48... ...
Many liability protections can be claim specific or position specific, there can be jurisdictional variances, and some liability protections may last only for the duration of an emergency while others may provide comprehensive immunity. Panel Discussion Monica Peek, professor of medicine at the University of Chicago, moderated a panel discussing health care worker fears of liability, standards in place for triggering CSC, and the use of COVID-19 vaccination status in triage protocols.
|
From page 49... ...
Peek then asked about using COVID-19 vaccination status in triage protocols. White noted that, "while our quick emotional impulse is to consider vaccination status when triaging patients, we must consider the current political and social climate." He recounted the story of a recent experience with an unvaccinated patient dying from COVID-19.
|
From page 50... ...
Scarce resources may involve critical care, such as lack of ventilators, health care workers, dialysis, or extracorporeal membrane oxygenation circuits, while scarce resources related to prevention may include monoclonal antibodies, antivirals, or vaccines. Ultimately, the objectives involved in equity and resource allocation are to (1)
|
From page 51... ...
Using a lottery or "first come, first served" approach is a way to randomly decide who receives care. However, Persad clarified, using nonpredictive criteria for resource allocation often fails to align or realize the objectives of preventing harm and mitigating health inequities as more disadvantaged groups die under the lottery approach (Tolchin et al., 2021)
|
From page 52... ...
She added that increasing community input when creating CSC and resource allocation standards will create a more transparent and trustworthy system by giving marginalized groups a seat at the table. Sederstrom critiqued methods of resource allocation she thought of as being a proxy for race, such as the SVI or patient zip codes, and suggested using race itself as an allocation criteria would be more effective in reducing inequities.
|
From page 53... ...
Panelists were asked for their thoughts on how implicit bias and provider education on CSC perpetuates racism and ableism1 in health care. Sequist stated that it is necessary to involve medical ethicists, or similar professionals with equal standing, along with the critical care physicians when providing input for creating CSC guidelines.
|
From page 54... ...
The COVID-19 pandemic has forced clinicians to make difficult decisions about the allocation of scarce resources, and it is essential that proper triage guidelines are in place and health care workers receive support when faced with making such tough decisions. Rushton also suggested considering if the threshold for implementing CSC is too high.
|
From page 55... ...
LEGAL, ETHICAL, AND EQUITY CONSIDERATIONS 55 as a critical resource that must be used in the best way to avoid burnout. To establish more trust and create more equity, Toner emphasized community engagement and seeking community opinions on CSC planning rather than waiting for the community's reaction to plans that have already been created.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.