Approaches to critical care resource allocation and triage during the COVID-19 pandemic: an examination from a developing world perspective

White DB, Katz MH, Luce JM, Lo B. Who should receive life support during a public health emergency? using ethical principles to improve allocation decisions. Ann Intern Med. 2009; 150(2): 132-8.

Lin JY, Anderson-Shaw L. Rationing of resources: ethical issues in disasters and epidemic situations. Prehosp Disaster Med. 2009; 24(3): 215-21.

Centre for Disease Control and Prevention. Ethical considerations for decision making regarding allocation of mechanical ventilators during a severe influenza pandemic or other public health emergency. [cited on February 2021];

Emanuel EJ, Persad G, Upshur R, et al. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med. 2020; 382(21): 2049-55.

Riccioni L, Bertolini G, Giannini A, et al. [Clinical ethics recommendations for the allocation of intensive care treatments, in exceptional, resource-limited circumstances.]. Recenti Prog Med. 2020; 111(4): 207-11. [in Italian]

O'Laughlin DT, Hick JL. Ethical issues in resource triage. Respir Care. 2008; 53(2): 190-7.

Iserson KV, Moskop JC. Triage in medicine, part I: concept, history, and types. Ann Emerg Med. 2007; 49(3): 275-81.

White DB, Lo B. A framework for rationing ventilators and critical care beds during the COVID-19 pandemic. JAMA. 2020; 323(18): 1773–4.9.

Peterson A, Largent EA, Karlawish J. Ethics of reallocating ventilators in the covid-19 pandemic. BMJ. 2020; 369: m1828.

Reid L. Triage of critical care resources in COVID-19: a stronger role for justice. J Med Ethics. 2020; 46(8): 526-30.

Hearn JD. Social utility and pandemic influenza triage. Med Law. 2013; 32(2): 177-89.

Braveman P, Gottlieb L. The social determinants of health: it's time to consider the causes of the causes. Public Health Rep. 2014; 129 (Suppl. 2): 19-31.

Papanicolas I, Woskie LR, Jha AK. Health care spending in the United States and other high-income countries JAMA. 2018; 319(10): 1024-39.

Krishnamoorthy V, Vavilala MS, Mock CN. The need for ventilators in the developing world: an opportunity to improve care and save lives. J Glob Health. 2014; 4(1): 010303.

Herreros B, Gella P, Real de Asua D. Triage during the COVID-19 epidemic in Spain: better and worse ethical arguments. J Med Ethics. 2020; 46: 455- 8.

Truog RD, Mitchell C, Daley GQ. The toughest triage - allocating ventilators in a pandemic. N Engl J Med. 2020; 382(21): 1973-1975.

Hull SC, Tolchin B. In triage decisions, age is not just a number — it's a matter of ethics. Medpage Today [cited on February 2021];

Rosenbaum L. Facing Covid-19 in Italy — ethics, logistics, and therapeutics on the epidemic’s front line. N Engl J Med. 2020; 382(20): 1873–5.

Ehni HJ, Wahl HW. Six propositions against ageism in the COVID-19 pandemic. J Aging Soc Policy. 2020; 32(4-5): 515-25.

Kuriyama, A, Ikegami, T, Nakayama, T. Impact of age on the discriminative ability of an emergency triage system: a cohort study. Acta Anaesthesiol Scand. 2019; 63(6): 781–8.

Jöbges S, Vinay R, Luyckx VA, Biller-Andorno N. Recommendations on COVID-19 triage: international comparison and ethical analysis. Bioethics. 2020 ;34(9): 948-59.

World Bank. Population ages 65 and above (% of total population). [cited on February 2021];

Koshy J. Coronavirus: Nearly 78% of COVID-19 patients in India are under 50: health ministry data. The Hindu. [cited on February 2021];

World Health Organization. Global status report on noncommunicable diseases [cited on February 2021];

Goodwin B. Justice by Lottery, 1thed. USA: University of Chicago Press; 1992.

Beauchamp TL, Childress JF. Principles of Biomedical Ethics, 5thed. UK: Oxford University Press; 2001.

dos Santos MJ, Martins MS, Santana FLP, et al. COVID-19: instruments for the allocation of mechanical ventilators—a narrative review. Crit Care. 2020; 24: 582.

Scheunemann LP, White DB. The ethics and reality of rationing in medicine. Chest. 2011; 140(6): 1625–32.

Broome J. Fairness versus doing the most good. Hastings Cent Rep. 1994; 24(4): 36–9.

Acharya R, Porwal A. A vulnerability index for the management of and response to the COVID-19 epidemic in India: an ecological study. Lancet Glob Health. 2020; 8(9): e1142–e1151.

De Castro L, Lopez AA, Hamoy G, Alba KC, Gundayao JC. A fair allocation approach to the ethics of scarce resources in the context of a pandemic: the need to prioritize the worst-off in the Philippines. Dev World Bioeth. 2020; 10.1111/dewb.12293.

Antommaria A. Conflicting duties and reciprocal obligations during a Pandemic. J Hosp Med. 2020; 15(5); 284-6.

Brock DW, Wikler D. Ethical issues in resource allocation, research, and new product development. In: Jamison DT, Breman JG, Measham AR, et al. eds. Disease Control Priorities in Developing Countries, 2nd ed. Washington (DC): World Bank Publications; 2006, Chap. 14.

Chature P, Gupta E. Sanitation workers on COVID-19 front lines: how to save the warriors? [cited on February 2021];

Zurani N, Hassan A, Dublin N. Review paper: organ transplants: ethical, social, and religious issues in a multicultural society. Asia Pac J Public Health. 2010;22(3):271-8.

McKneally MF, Sade RM. The prisoner dilemma: should convicted felons have the same access to heart transplantation as ordinary citizens? opposing views. The Journal of Thoracic and Cardiovascular Surgery. 2003; 125(3): 451–3.

Radhakrishnan V, Sen S. Data | 70% prisoners in India are undertrials. [cited on February 2021];

Uhlenberg P. Death and the family. J Fam Hist. 1980; 5(3): 313-20.

Mossialos E, King D. Citizens and rationing: analysis of a European survey. Health Policy. 1999; 49(1-2): 75–135.

Olsen JA, Richardson J, Mortimer D. Priority setting in the public health service: results of an Australian survey. [cited on February 2021];

Schwappach DLB. Resource allocation, social values and the QALY: a review of the debate and empirical evidence. Heal Expect. 2002; 5(3): 210–22.

Stafinski T, McCabe C, Menon D. Determining social values for resource allocation decision-making in cancer care: a Canadian experiment. Journal of Cancer Policy. 2014; 2(3): 81–8.

Alden DL, Friend J, Lee PY, Lee YK, Trevena L, Ng CJ, et al. Who decides: me or we? family involvement in medical decision making in Eastern and Western Countries. Med Decis Making. 2018; 38(1): 14-25.

Machan T. Liberalism and Atomistic Individualism. In: Narveson J, Dimock S, eds. Liberalism: New Essays on Liberal Themes, 1sted. Dordrecht: Springer; 2001.

Graham J, Nosek BA, Haidt J, Iyer R, Koleva S, Ditto PH. Mapping the moral domain. J Pers Soc Psychol. 2011; 101(2): 366-85.

IssueVol 14 (2021) QRcode
COVID-19; Triage; Resource allocation; Ethics; Health resources; Supply and distribution.

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Basu S. Approaches to critical care resource allocation and triage during the COVID-19 pandemic: an examination from a developing world perspective. J Med Ethics Hist Med. 2021;14.