Special Issue "The Rationing of Health Resources in Emergency Conditions and Decision Making under Scarcity"

A special issue of Philosophies (ISSN 2409-9287). This special issue belongs to the section "Virtues".

Deadline for manuscript submissions: 25 July 2022 | Viewed by 1120

Special Issue Editor

Prof. Dr. Fabrizio Turoldo
E-Mail Website
Guest Editor
Department of Philosophy and Cultural Heritage, “Ca’ Foscari” University of Venice, 30123 Venice, Italy
Interests: Bioethics; Moral Philosophy

Special Issue Information

Dear Colleagues,

The COVID-19 pandemic has brought our attention back to the management and equitable distribution of limited health resources. Initially, the debate focused on intensive care beds and the availability of respirators. Later, the focus shifted to access to vaccines.

The intent of this issue is not so much to reflect on what happened during the pandemic, but to look to the future: What can we learn from the pandemic. Are we better prepared to face other similar challenges in the future? Have we found values or principles that could guide us in equally difficult choices in the future? Would the ethical principles that have guided us in this pandemic work in the future?

The criteria used for access to intensive care were different from those used for vaccines. In the case of vaccines, priority was given to the elderly, whereas in intensive care, the elderly had no priority. Essentially, suggestions were made to give priority to young people when it came to allocating ICU beds. Our question is, should age be used as an allocation criterion in the future, and in what sense? Would it be ethical and cost-effective, and could it be evaluated objectively? Would it achieve the greatest good for the greatest number? Or, is using age as a criterion always an instance of ageism and unfair discrimination?

Almost all countries started their vaccination programs with the elderly. The rationale was that they were the most vulnerable and most likely to die from coronavirus. However, what if a future threat would be equally dangerous across the age groups? Should we still prioritize, and if we should, on what criteria? Should we give priority to the young, so that they would have a better chance of reaching a normal life expectancy? Or should we prioritize those with reproductive capabilities to secure the continuation of the human race? Or perhaps we should start with the essential workers and those whose contributions keep the basic functions of the society running?

A further problem is the bedside decision making: "who decides the triage?". In the COVID-19 pandemic, two competing models have been suggested. Some preferred external committees deciding the ICU bed allocation, whereas others thought that this reduces doctors to technicians and would prefer doctors as decision makers. Both models have their advantages and disadvantages and need to be studied further.

An extension of the bedside triage problem is the decision making on a national and perhaps even international level. Who should make the public health policy decisions that affect everyone’s lives? In democracies, the elected representatives of the public should surely have their say, but given that public health crises are beyond their expertise, other players need to be included as well. If the COVID-19 pandemic has taught us anything, it is that we are not well prepared to respond to crises of this sort in efficient ways. Procedures to aptly respond to future crises, that can be initiated at a very short notice, should be put in place. Their shape and form need to be carefully considered.

An additional problem is to understand what is the different value of the guidelines that are proposed to doctors. Some guidelines are created by scientific societies, sometimes composed only of doctors. Other guidelines are developed by ethics committees that have interdisciplinary expertise within them. Further guidelines are issued by elected governments or supranational legal entities. What relationship can or should there be between these different guidelines?

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but not limited to) the following: 

  • Allocation of health resources and theories of justice;
  • Criteria for allocation of life-saving resources;
  • Conflicts to secure limited resources and their management;
  • Rationing of health resources in emergency conditions;
  • Decision making under scarcity;
  • Inequalities in health and well-being;
  • The philosophical discussion on the age criterion for the selection of patients;
  • Age discrimination in healthcare;
  • Clinical ethics at the test of pandemics;
  • Ethics committees as a resource during emergencies;
  • Informed consent during pandemics and in emergency situations;
  • The problem of trust in scientific and health authorities;
  • The relationship between doctors’ responsibilities and guidelines in extraordinary situations. 

I look forward to receiving your contributions.

Prof. Dr. Fabrizio Turoldo
Guest Editor

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Published Papers (2 papers)

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Research

Article
Ethics in Emergency Times: The Case of COVID-19
Philosophies 2022, 7(3), 70; https://doi.org/10.3390/philosophies7030070 - 20 Jun 2022
Viewed by 185
Abstract
A disaster is an occurrence disrupting a community’s normal functioning and existence. The disruption may render it impossible to comply with principles and to respect, protect, and fulfill rights as it happens in ordinary times; it may induce an overwhelming shortage of resources [...] Read more.
A disaster is an occurrence disrupting a community’s normal functioning and existence. The disruption may render it impossible to comply with principles and to respect, protect, and fulfill rights as it happens in ordinary times; it may induce an overwhelming shortage of resources and make tragic decisions unavoidable. From its very beginning, the COVID-19 pandemic evoked the scenario of disaster medicine, where triage is likely to imply not simply postponing a treatment but letting someone die. However, it is not only the health care system that faces disruption risks. Lockdown measures and other restrictions were imposed to curb the pandemic, impinging upon individual freedom as well as economic activities. The proposal of mandatory vaccination implied a suspension of the principle of autonomy, which is a fundamental pillar of modern medicine. Out of the ordinary balancing efforts may be required, and two questions arise. Do such exceptional circumstances suggest reconsidering the criteria to apply, especially when essential, life-saving treatments are at stake? Who should decide? Science offers the premises to build on, but the last word does not belong to science. It remains the province of ethics and politics. Full article
Article
Scarcity, Justice, and Health Crisis Leadership
Philosophies 2022, 7(3), 48; https://doi.org/10.3390/philosophies7030048 - 23 Apr 2022
Viewed by 720
Abstract
The COVID-19 pandemic has created or revealed scarcities in many domains: medical, civic, economic, and ideological. Responses to these are analyzed in the framework of a map of justice and an imperative of openness. The main argument is that whatever the view of [...] Read more.
The COVID-19 pandemic has created or revealed scarcities in many domains: medical, civic, economic, and ideological. Responses to these are analyzed in the framework of a map of justice and an imperative of openness. The main argument is that whatever the view of justice chosen by public health authorities, they should be able and willing to disclose it to the citizens. Objections are considered and qualifications added, but the general conclusion is that in liberal democracies, truth-telling by those in power, although politically hazardous, would be ethically advisable. Full article
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