Translating theories of justice into a practice model for triage of scarce intensive care resources during a pandemic

Bibliographic Data

ID21504262
AuthorsKathrin Knochel (0000-0003-4013-5906, Clinical Ethics, School of Medicine, Institute of History and Ethics in Medicine Technical University of Munich Munich Germany, corresponding author), Eva‐Maria Schmolke (Clinical Ethics, School of Medicine, Institute of History and Ethics in Medicine Technical University of Munich Munich Germany), Lukas J Meier (0000-0002-3316-3928, University of Cambridge), Lukas Meier (Clinical Ethics, School of Medicine, Institute of History and Ethics in Medicine Technical University of Munich Munich Germany), Alena Buyx (0000-0002-5726-7633, Clinical Ethics, School of Medicine, Institute of History and Ethics in Medicine Technical University of Munich Munich Germany)
Year2024
Volume38
Issue3
Pages223-232
Publication date2024-03-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBioethics (JOURNAL)
Journal identifiersISSN: 0269-9702 • E-ISSN: 1467-8519
PublisherWiley (PUBLISHER • GB)
DOI10.1111/bioe.13198
PMID37382040
OpenAlexW4382502214
LanguageEN
Citations received2
References cited2

During the COVID‐19 pandemic, national triage guidelines were developed to address the anticipated shortage of life‐saving resources, should ICU capacities be overloaded. Rationing and triage imply that in addition to individual patient interests, interests of population health have to be integrated. The transfer of theoretical and empirical knowledge into feasible and useful practice models and their implementation in clinical settings need to be improved. This paper analyzes how triage protocols could translate abstract theories of distributive justice into concrete material and procedural criteria for rationing intensive care resources during a pandemic. We reconstruct the development and implementation of a rationing protocol at a German university hospital: describing the ethical challenge of triage, clarifying the aspirational norms, and summarizing specific norms of fair triage and allocation for developing an institutional policy and practice model and implementing it. We reflect on how critical topics are seen by clinicians and what helped manage the perceived burdens of the triage dilemma. We analyze what can be learned from this debate regarding the difficult issues around triage protocols and their potential implementation into clinical settings. Analyzing the ought‐to‐is gap of triage, integrating abstract ethical principles into practical concepts, and evaluating those should clarify the benefits and risks of different allocation options. We seek to inform debates on triage concepts and policies to ensure the best possible treatment and fair allocation of resources as well as to help protect patients and professionals in worst‐case scenarios

Economic Justice · Economics · Intensive care · Intensive care medicine · Medical emergency · Pandemic · Political science · Scarcity · Sociology · Triage · Disaster Response and Management · Law · Medicine · Psychology