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Comment
. 2021 Sep;51(5):18-29.
doi: 10.1002/hast.1283.

Life-Years & Rationing in the Covid-19 Pandemic: A Critical Analysis

MaryKatherine Gaurke, Bernard Prusak, Kyeong Yun Jeong, Emily Scire, Daniel P Sulmasy
Comment

Life-Years & Rationing in the Covid-19 Pandemic: A Critical Analysis

MaryKatherine Gaurke et al. Hastings Cent Rep. 2021 Sep.

Abstract

Prominent bioethicists have promoted the preservation of life-years as a rationing strategy in response to the Covid-19 pandemic. Yet the philosophical justification for maximizing life-years is underdeveloped and has a complex history that is not reflected in recent literature. In this article, we offer a critical investigation of the use of life-years, arguing that evidence of public support for the life-years approach is thin and that organ transplantation protocols (heavily cited in pandemic-response protocols) do not provide a precedent for seeking to save the most life-years. We point out that many state emergency-response plans ultimately rejected or severely attenuated the meaning of saving the most life-years, and we argue that philosophical arguments in support of rationing by life-years are remarkably wanting. We conclude by offering a fair alternative that adheres to the standard duties of beneficence, respect for persons, and justice.

Keywords: life-years; public health ethic; resource allocation.

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References

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    1. See, for example, Hospital & Healthsystem Association of Pennsylvania , Interim Pennsylvania Crisis Standards of Care for Pandemic Guidelines, version 2, (Pennsylvania Department of Health, April 10, 2020), https://www.health.pa.gov/topics/Documents/Diseases%20and%20Conditions/C..., pp. 30‐33; Subject Matter Experts Advisory Panel for the Governor's Expert Emergency Epidemic Response Committee, Crisis Standards of Care Guidelines for Hospitals for the COVID‐19 Pandemic, version 2.0 (Colorado Department of Public Health & Environment, April 26, 2020), 34, at https://www.colorado.gov/pacific/cdphe/colorado-crisis-standards-care; Executive Office of Health and Human Services, Crisis Standards of Care Planning Guidance for the COVID‐19 Pandemic (Commonwealth of Massachusetts, Department of Public Health, April 7, 2020), 16‐17, 21, at COVID‐19 Public Health Guidance and Directives, https://www.mass.gov/info-details/covid-19-public-health-guidance-and-di...; Oklahoma State Department of Health, “Hospital Crisis Standards of Care: Resource Reference Cards,” April 7, 2020, https://www.ok.gov/health2/documents/Hospital%20Crisis%20Standards%20of%..., p. 28; Missouri Hospital Association, A Framework for Managing the 2020 COVID‐19 Pandemic Response and Implementing Crisis Standards of Care, version 1.0 (April 6, 2020), https://medicine.missouri.edu/sites/default/files/A_Framework_for_Managi..., p. 18; State of New Jersey Department of Health, “Allocation of Critical Care Resources during a Public Health Emergency,” April 11, 2020, https://nj.gov/health/legal/covid19/FinalAllocationPolicy4.11.20v2%20.pdf, pp. 8‐9. This final source, from New Jersey, notes that it is “[a]dapted from the University of Pittsburgh Model Policy”; the March 26, 2020, version of this policy, “Allocation of Scarce Critical Care Resources during a Public Health Emergency,” from the Department of Critical Care Medicine at the University of Pittsburgh School of Medicine, is available as the second document in an appendix here: jvp200068supp1_prod.pdf. We have conducted a comprehensive review of state protocols and emergency response plans and have carefully differentiated the plans based on their use of life‐years, fair innings, and other age‐based criteria for resource allocation. E. Scire et al., “Rationing with Respect to Age during a Pandemic: A Comparative Analysis of State Pandemic Preparedness Plans” (unpublished manuscript, 2020), Microsoft Word file.
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