PHIL 1040G Tutorial Notes- Week 3
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PHIL1040G: Law, Ethics, and Politics
Tutorial #3
Pandemic Response: Allocation of Scarce Medical Resources
Shift in discussion from first two weeks of lecture and last week (law and politics » ethics).
What does ‘allocation of scarce resources’ mean? How is it relevant to COVID-19?
Important concepts
Triage
: the sorting of and allocation of treatment to patients and especially battle and disaster victims according
to a system of priorities designed to maximize the number of survivors
Ageism
: prejudice or discrimination on the grounds of a person's age.
Disablism
: discriminatory, oppressive, abusive behavior arising from the belief that disabled people are inferior
to others.
Relevant principles: Section 7 and Section 15 of the Charter of Rights and Freedoms. Readings
Ballantyne, “ICU triage: How many lives or whose lives?”
This article is meant to draw your attention to the issue at hand—the distribution of limited medical resources peak pandemic—and highlight the “tension” between utility
(saving the most lives) and equity (fairness/ discrimination) when it comes to hospital guidelines. Ballantyne asks why triage methods have focused less on equity and concludes with demonstrating the negative consequences of a “utility-focused triage approach” on social and ethnic health disparities.
ICUs overwhelmed » ethical dilemma:
‘what is the ethical way to allocate limited medical resources?”
Cites bioethicists who advocated for a utility-focused triage approach in hospitals.
They believe guidelines should instead focus heavily on saving more lives
—especially those with a better chance of survival—and disregard equity and discrimination.
Ethically speaking, “many” matters more than the “who.”
Why would a utility-focused triage approach be problematic?
(Hint: “entrenched privilege?”)
To back her point, Ballantyne cites relevant statistics/facts:
“Comorbidities are not evenly distributed amongst the population. Underlying health status correlates with privilege based
ethnicity and wealth. Current evidence suggests that people with hypertension, cardiovascular disease, chronic obstructive
pulmonary disease (COPD), and cancer are more likely to die from severe COVID19. In New Zealand for example prevalence
of multimorbidity (two or more conditions) is higher for Māori (13.4%) and Pacific ethnic groups (13.8%) than for NZ
Europeans (7.6% prevalence). Multimorbidity is also more common for people in areas of higher socioeconomic deprivation.
Māori aged 45 and over have a COPD hospitalisation rate over 3.5 times that of non-Māori. When you plug the clinical status
of individuals into an ICU triage tool aimed at maximising population survival rates you will get results that reflect these social
and ethnic divisions.”
Colenda et al. “COVID-19 Pandemic and Ageism: A Call for Humanitarian Care”
A group of geriatricians discussing issues pertaining to ageism and COVID-19. They end with a proposal of
4 recommendations that they believe should be given greater attention to in healthcare. Jackie L. Scully, “Disablism in a Time of Pandemic: Some Things Don’t Change”
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PHIL1040G: Law, Ethics, and Politics
Tutorial #3
Scully argues that a utility-focused triage approach is an
“…indicator of our ongoing inability as a society to consider people with disabilities as equal members of the community, with equal human and civil rights, equal claims to citizenship, and equal moral agency.” She concludes by arguing that ICU guidelines should include BOTH the criteria for triage decisions AND the reasoning behind them and she offers recommendations that avoids the concerns she raises.
Scully states that we make assumptions about (i) the overall health status
of disabled people; (ii) their quality
of life; and (iii) their social utility.
Important to consider because this influences evaluations about prioritizing limited medical resources.
Question: What does it mean to make these assumptions? Consider these assumptions and how you would compare the health status, quality of life, and social utility between an Olympic swimmer and a paraplegic.
For example, basing allocation on social utility alone means you must adopt some standards or rules about how you would go about evaluating how useless one is to society. Think about: Who would set these standards—would they be nation wide, province-specific? Can you think of some standards? How do you decipher one person’s quality of life over another’s?
Emanual et al., “Fair Allocation of Scarce Medical Resources in the Time of Covid-19”
Important:
You should critically engage with their recommendations—What consequences would they have in the ICU. Think about their fairness (w/r to the Charter of Rights and Freedoms)—Are they justified?
Four principles of fairness
that triage protocols should be guided by:
i.
Maximizing the benefits produced by scarce resources: “can be understood as saving the most individual lives or as saving the most life-years by giving priority to patients likely to survive longest
after treatment” (2051)
Most important principle.
Focus is on the outcome and the value of the outcome.
Utilitarian approach. Utilitarianism:
A theory of morality that advocates actions that foster happiness for the greatest number of people (the ‘greater good’). When directed toward making social/political decisions, a utilitarian philosophy aims for the betterment of society as a whole
.
What are the flaws of utilitarianism?
These principles of ethics yield 6 recommendations
for allocating medical resources:
1.
Maximize benefits should be highest priority.
“Saving more lives and more years of life is a consensus value across expert report” (2052).
“Limited time and information in a Covid-19 pandemic make it justifiable to give priority to maximizing
the number of patients that survive treatment with a reasonable life expectancy and to regard maximizing
improvements in length of life as a subordinate aim” (2052).
Question:
Consider the principles that Emaneul et al., provide for ethical guidance pertaining to medical decisions about the fair allocation of limited resources during the Covid-19 pandemic. Explain their first recommendation and the reasons behind it. Formulate and explain at one challenge to this recommendation 2
PHIL1040G: Law, Ethics, and Politics
Tutorial #3
that draws on the views of at either Scully, Ballantyne, or Colenda et al. Between Emanuel et al. and the other author(s), who do you think has the most convincing view? Explain and defend your answer.
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