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Hastings Center News

Crisis Standards of Care: New in the Hastings Center Report

As Covid spreads and leaves intensive care units at or near capacity in several states, some regions have approved crisis standards of care, which involve health care rationing. The latest Hastings Center Report (September – October 2021) features a collection of pieces on the debates about crisis standards of care—the guidelines for the allocation of health care resources if those resources are too scarce to meet the needs of all patients.

Life-Years & Rationing in the Covid-19 Pandemic: A Critical Analysis

MaryKatherine Gaurke, Bernard Prusak, Kyeong Yun Jeong, Emily Scire, Daniel P. Sulmasy

Prominent bioethicists have promoted the preservation of life-years as a rationing strategy in response to the Covid-19 pandemic. This article offers a critical investigation of the use of life-years, arguing that the evidence of public support for this approach is thin. The authors offer an alternative that adheres to the standard duties of beneficence, respect for persons, and justice.

The University of California Crisis Standards of Care: Public Reasoning for Socially Responsible Medicine

Alex Rajczi, Judith Daar, Aaron Kheriaty, Cyrus Dastur

This article highlights crucial components of the University of California crisis standards of care triage procedures, developed by a bioethics working group in response to the Covid-19 pandemic. The recommendations are distinctive because of the emphasis placed on grounding decisions on the public’s preference for triage protocols. The article contrasts the UC procedures with the triage procedures known as the “Pittsburgh framework.” Among the specific topics discussed are age discrimination, disability discrimination, the prioritization of critical workers for scarce resource, and triage priority for pregnant patients.

Other Voices: Five commentaries offer further arguments and insights into crisis standards of care:

Structural Inequities, Fair Opportunity, and the Allocation of Scarce ICU Resources,” by Douglas B. White, Bernard Lo

Against Exclusive Survivalism: Preventing Lost Life and Protecting the Disadvantaged in Resource Allocation,” by Govind Persad

“Centering Social Justice for Covid-19 Resources and Research,” by Virginia A. Brown

“Crisis Standards of Care: More Than Just a Thought Experiment?” by Anuj B. Mehta and Matthew K. Wynia

“Ventilator Allocation Protocols: Sophisticated Bioethics for an Unworkable Strategy,” by Robert D. Truog

Table of contents of the September-October 2021 Hastings Center Report: https://onlinelibrary.wiley.com/toc/1552146x/2021/51/5

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