An Approach for Rationing Care During the Pandemic

Amid growing fears that the United States could face a shortage of ventilators for coronavirus patients, state officials, bioethicists and hospitals are conferring with state health officials to hammer out their policies to determine which coronavirus patients would get ventilators if they run short — essentially deciding whose lives to save first.

In Maryland, these discussions include how to factor in age, pre-existing health conditions, overall life expectancy and other criteria to determine which patients would have priority if there are not enough ventilators. These talks have been informed by a 2009 Berman Institute study into the allocation of scarce medical resources.

Berman Institute faculty Ruth Faden and Alan Regenberg, along with JHU collaborators Lee Daugherty Biddison and Eric Toner shared insights from their project in the March 12 Washington Post commentary, “U.S. hospitals may have to ration care during the pandemic. Here’s one approach.”

“After the 2009 H1N1 pandemic, in a calm between emergencies, we and other collaborators engaged the Maryland public in a discussion of ventilator rationing during a pandemic. Over the course of 18 months, we hosted 15 day-long forums across the state with over 300 participants (both laypeople and health-care professionals) to encourage in-depth conversations about the brutal challenges that rationing presents — and about the community values that should guide allocation. …”

“It is appropriate and accurate to reassure the public that most people who contract Covid-19 will recover fully on their own. At the same time, the public needs to be prepared for the possibility of more dire scenarios. Participants in our study were adamant that politicians, and health officials, be transparent and honest about the prospect of and plans for the rationing of ventilators and other equipment. In health emergencies, experts often ask the public to heed the advice of public health professionals; in the case of planning for situations involving scarcity, it is equally important that the experts heed the advice of the public.”