Sequential organ failure assessment, ventilator rationing and evolving triage guidance: new evidence underlines the need to recognise and revise, unjust allocation frameworks

Journal of Medical Ethics 48 (2):136-138 (2022)
  Copy   BIBTEX

Abstract

We respond to recent comments on our proposal to improve justice in ventilator triage, in which we used as an example New Jersey’s publicly available and legally binding Directive Number 2020-03. We agree with Bernard Lo and Doug White that equity implications of triage frameworks should be continually reassessed, which is why we offered six concrete options for improvement, and called for monitoring the consequences of adopted triage models. We disagree with their assessment that we mis-characterised their Model Guidance, as included in the NJ Directive, in ways that undermine our conclusions. They suggest we erroneously described their model as a two-criterion allocation framework; that recognising other operant criterion reveals it ‘likely mitigate[s] rather than exacerbate[s] racial disparities during triage’, and allege that concerns about inequitable outcomes are ‘without evidence’. We highlight two major studies robustly demonstrating why concerns about disparate outcomes are justified. We also show that White and Lo seek to retrospectively—and counterfactually—correct the version of the Model Guideline included in the NJ Directive. However, as our facsimile reproductions show, neither the alleged four-criteria form, nor other key changes, such as dropping the Sequential Organ Failure Assessment score, are found in the Directive. These points matter because our conclusions hence stand, because the public version of the Model Guidance had not been updated to reduce the risk of inequitable outcomes until June 2021 and NJ’s Directive still does not reflect these revisions, and, hence, represents a less equitable version, as acknowledged by its authors. We comment on broader policy implications and call for ways of ensuring accurate, transparent and timely updates for users of high-stakes guidelines.

Links

PhilArchive



    Upload a copy of this work     Papers currently archived: 76,199

External links

Setup an account with your affiliations in order to access resources via your University's proxy server

Through your library

Similar books and articles

The Ethical Unjustifications of COVID-19 Triage Committees.Yi Jiao Tian - 2021 - Journal of Bioethical Inquiry 18 (4):621-628.
Against Personal Ventilator Reallocation.Joel Michael Reynolds, Laura Guidry-Grimes & Katie Savin - 2020 - Cambridge Quarterly of Healthcare Ethics 30 (2):272-284.
Rational rationing?Bob Brecher - 2008 - Clinical Ethics 3 (2):53-54.

Analytics

Added to PP
2022-01-21

Downloads
8 (#988,190)

6 months
5 (#153,645)

Historical graph of downloads
How can I increase my downloads?