Question

outline a Triage Policy for Setting Priorities for ICU Beds During a Pandemic. Include information on how a hospital should fairly and justly decide who has priority when there is a shortage of ICU beds and trained staff to provide support for patients needing ventilator support. Also include policies that address the removal of life sustaining support from terminally ill patients in the case of a shortage of such care. Will this be allowed or not? Support your policies using ethical principles.

Answer 1

A triage algorithm based on clinical estimations of the incremental survival benefit( saving most life years) provided by ICU care is proposed. First come,first served is used to choose between individuals with equal priorities and benefits. It has 4 prioritisation categories:

• performance score
• ASA score
• number of organ failures
• predicted survival

The current COVID 19 pandemic has witnessed the use of age as a criteria, primarily because advanced age appears strongly associated with poorer outcomes.

In ordinary clinical practice, patients who require life support receive them, except if they or their surrogates refuse or in the rare circumstances in which they are deemed medically futile. Physicians do not withdraw mechanical ventilation against a patients wish in order to provide it to someone else.
Public health ethics differ from clinical ethics by giving priority to promoting the common good over protecting individual autonomy. A shortage of ventilators in a public health emergency may require physicians to withhold or withdraw mechanical ventilation against their own clinical intuitions and against the wishes of some patients who otherwise might survive.

outline of triage policy: