Building an Ethics Framework for COVID-19 Resource Allocation: The How and the Why
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SYMPOSIUM: COVID-19
Building an Ethics Framework for COVID-19 Resource Allocation: The How and the Why Angus Dawson
Received: 18 May 2020 / Accepted: 3 August 2020 # Journal of Bioethical Inquiry Pty Ltd. 2020
Abstract This paper expands on “An Ethics Framework for Making Resource Allocation Decisions within Clinical Care: Responding to COVID-19,” which is also published in this special issue of the Journal of Bioethical Inquiry. I first describe and explain the steps we took to develop this framework, drawing on previous experience and literature to explain what frameworks can and cannot do. I distinguish frameworks from other kinds of guidance and justify why our framework takes the form it does. Our key aim was to help answer practical questions faced by frontline clinicians. I then explain some of the normative issues that shape the content of the framework itself. Here, I engage critically with the resource allocation literature and justify the particular positions that we take in the framework. Although we undertook this work to address resource allocation decisions anticipated during the unfolding COVID-19 pandemic, it will also serve as an example for others who wish to design practical ethics frameworks for other bioethical issues that will emerge in the future.
Keywords Decision-making . Frameworks . Resource allocation . Ethics . COVID-19
A. Dawson (*) Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, Level 1, Medical Foundation Building K25, Sydney, NSW 2006, Australia e-mail: [email protected]
Background This paper is designed to be complementary to and expand upon the particular framework that is published elsewhere in this journal: “An Ethics Framework for Making Resource Allocation Decisions within Clinical Care: Responding to COVID-19” (Dawson et al. 2020). In this brief paper I focus on two key tasks. First, I describe the aims behind the framework and the process of its formation and discuss some of the theoretical and practical reasons why it takes the format that it does. Second, I outline and provide some justification for the particular positions that the framework proposes and respond to some possible objections. The framework (Dawson et al. 2020) was produced by an ad hoc committee set up within Sydney Health Ethics at the University of Sydney, Australia. It was a collaboration of clinicians with relevant expertise, clinical ethicists, and academics with expertise in ethics. The framework was produced via five meetings in ten days from first enquiry to publication on the Sydney Health Ethics website on the April 2, 2020. We had to move quickly because (in late March 2020) it was feared that hospitals in New South Wales could have faced the kind of scarcity of vital health resources where such a framework would be implemented. At that time, there was no suitable guidance for the specific New South Wales context. Available documents tended to focus on more technical issues related to how to allocate “scores” to patients within triage systems.
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