An Ethics Framework for Making Resource Allocation Decisions Within Clinical Care: Responding to COVID-19
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SYMPOSIUM: COVID-19
An Ethics Framework for Making Resource Allocation Decisions Within Clinical Care: Responding to COVID-19 Angus Dawson & David Isaacs & Melanie Jansen & Christopher Jordens & Ian Kerridge & Ulrik Kihlbom & Henry Kilham & Anne Preisz & Linda Sheahan & George Skowronski
Received: 20 April 2020 / Accepted: 3 August 2020 # Journal of Bioethical Inquiry Pty Ltd. 2020
Abstract On March, 24, 2020, 818 cases of COVID-19 had been reported in New South Wales, Australia, and new cases were increasing at an exponential rate. In anticipation of resource constraints arising in clinical settings as a result of the COVID-19 pandemic, a working party of ten ethicists (seven clinicians and three fulltime academics) was convened at the University of Sydney to draft an ethics framework to support resource allocation decisions. The framework guides decisionmakers using a question-and-answer format, in language that avoids philosophical and medical technicality. The working party met five times over the following week and then submitted a draft Framework for consideration by two groups of intensivists and one group of academic ethicists. It was also presented to a panel on a national current affairs programme. The Framework
was then revised on the basis of feedback from these sources and made publicly available online on April 3, ten days after the initial meeting. The framework is published here in full to stimulate ongoing discussion about rapid development of user-friendly clinical ethics resources in ongoing and future pandemics. Keywords Ethics framework . Resource allocation . Clinical care . Decision-making . COVID-19 . Pandemic . Australia . New South Wales
Background This ethics framework is designed to help clinicians, hospital administrators, and policymakers decide how
A. Dawson : D. Isaacs : C. Jordens (*) : I. Kerridge : H. Kilham : A. Preisz : L. Sheahan : G. Skowronski Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006, Australia e-mail: [email protected]
A. Preisz e-mail: [email protected]
A. Dawson e-mail: [email protected]
G. Skowronski e-mail: [email protected]
D. Isaacs e-mail: [email protected]
D. Isaacs : M. Jansen : H. Kilham The Children’s Hospital Westmead, Sydney, Australia
L. Sheahan e-mail: [email protected]
I. Kerridge e-mail: [email protected] H. Kilham e-mail: [email protected]
M. Jansen e-mail: [email protected]
Bioethical Inquiry
to allocate clinical health resources as they become scarce within a pandemic such as COVID-19. Such a framework “frames” decision-making; it does not list or stipulate general answers. Much will be left to expert judgement in response to different circumstances as they arise. Instead of listing a set of abstract values, principles, and rules, this framework aims to help with decision-making by structuring the relevant issues to be considered in the form of a series of questions and answers to ensure it pro
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