Lottery for ventilators

August 05, 2020

As cases of COVID-19 rise around the world, there has been a surge in the hospitalisation of COVID-19 patients in the United States, India and Brazil. Many are concerned by the ability of the healthcare systems to cope under the strain, particularly the availability of critical resources such as ventilators.

In times of acute shortages, the orthodoxy in healthcare is for scarce resources to be allocated based on who has the best chance of survival. However, Dr Diego Silva, a lecturer in bioethics at the University of Sydney, argues allocation decisions based on a simple utility calculus are unjust because they exacerbate existing social inequities.

In a paper published in Chest Journal, Dr Silva proposes a radical departure from current convention by arguing ventilators be allocated to COVID-19 patients via a lottery.

"At a population level, 'wealth equals health' is accurate. The opposite is also true, poverty leads to ill health. Those who are least likely to contract or die from coronavirus are the young and healthy. So, if saving the most lives favours saving people most likely to physically improve from their symptoms, we are indirectly further disadvantaging the economically poor and socially marginalised," Dr Silva said.

"Allocation based on lottery is also an expression of utility and maximising public resources, it would remove the likelihood of people being given preferential treatment because of social or economic advantages.

"Using a lottery system to allocate ventilators during a pandemic may sound wrong and all else being equal, we should maximise the number of lives saved. However, there's the rub: society pre-COVID-19 was not equal, nor is it during this pandemic. If we believe in a fair, just and equal society the only way to achieve this in a healthcare system is to give everyone an equal chance of receiving critical medical care."

Until now, Italy has been the only country that has experienced an acute shortage of ventilators during the pandemic, however there are concerns some states in the United States, and parts of Brazil and India, may have to confront similar shortages.

There are already troubling signs in the United States. Arizona currently has more than 50 percent of available ventilators in use. More than 50 hospitals across Florida have said there are no ICU beds available.

"Rationing medical care is not something many doctors and health administrators would have a lot of experience with. Usually, the allocation of health resources can be done with time on one's side and there is rarely - if ever - acute scarcity. I would urge hospitals in places where there is a worrying surge in coronavirus cases to start thinking about this ethical dilemma now, so that they are prepared if the hospital systems get inundated with COVID-19 patients," Dr Silva said.

University of Sydney

Related Pandemic Articles from Brightsurf:

Areas where the next pandemic could emerge are revealed
An international team of human- and animal health experts has incorporated environmental, social and economic considerations -- including air transit centrality - to identify key areas at risk of leading to the next pandemic.

Narcissists love being pandemic 'essential workers'
There's one group of essential workers who especially enjoy being called a ''hero'' during the COVID-19 pandemic: narcissists.

COVID-19: Air quality influences the pandemic
An interdisciplinary team from the University of Geneva and the ETH Z├╝rich spin-off Meteodat investigated possible interactions between acutely elevated levels of fine particulate matter and the virulence of the coronavirus disease.

People who purchased firearms during pandemic more likely to be suicidal
People who purchase a firearm during the pandemic are more likely to be suicidal than other firearm owners, according to a Rutgers study.

Measles outbreaks likely in wake of COVID-19 pandemic
Major measles outbreaks will likely occur during 2021 as an unexpected consequence of the COVID-19 pandemic, according to a new academic article.

The COVID-19 pandemic: How US universities responded
A new George Mason University study found that the majority of university announcements occurred on the same day as the World Health Organization's pandemic declaration.

Researchers find evidence of pandemic fatigue
A new study from the USC Leonard Davis School of Gerontology shows that the behavioral responses to COVID-19 differed by age.

Excessive alcohol consumption during the COVID-19 pandemic
The full impact of COVID-19 on alcohol use is not yet known, but rates have been rising during the first few months of the pandemic.

How fear encourages physical distancing during pandemic
Despite guidelines plastered on the walls and floors of grocery and retail stores encouraging customers to maintain six-feet of physical distance during the pandemic, many do not.

COVID-19 pandemic and $16 trillion virus
This Viewpoint aggregates mortality, morbidity, mental health conditions, and direct economic losses to estimate the total cost of the pandemic in the US on the optimistic assumption that it will be substantially contained by the fall of 2021.

Read More: Pandemic News and Pandemic Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to