The Crisis in Standards of Care

Abstract

Since the start of the Covid-19 pandemic, debates have waged about "crisis standards of care" ("CSC")-the guidelines for the allocation of resources if those resources are too scarce to meet the needs of all patients. The Hastings Center Report's September-October 2021 issue features a collection of pieces on this debate. In the lead article, MaryKatherine Gaurke and colleagues object to the idea that the allocation of scarce resources should aim to save the most "life-years," arguing instead that the objective should be to save the most lives. Gaurke et al. assert that it is only theorists who have favored the life-years strategy; the public has not-or at least, there is no good evidence that the public has. This claim is elaborated in the article by Alex Rajczi and colleagues, who argue that identifying and applying the public's will-a process they call "political reasoning"-is the core work in developing CSC. Five commentaries-two coauthored, by Douglas B. White and Bernardo Lo and by Anuj B. Mehta and Matthew K. Wynia, and three solo authored, by Govind Persad, Virginia A. Brown, and Robert D. Truog-offer further arguments about and insights into CSC.

Keywords: Covid-19; allocation of scarce resources; clinical ethics; crisis standards of care; equity; medical decision-making; principles of bioethics.