Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The ethics of rationing care during COVID

M. Bennet Broner, PhD
Policy
January 8, 2021
113 Shares
Share
Tweet
Share

I recently read an opinion by a physician regarding the decision as to which COVID patient would receive care and which would not when hospitals became too full to care for every patient. He suggested that no one need be denied care if some structural changes were made in health care delivery. Given the expected post-Christmas/New Year tsunami of new cases; and limited supplies, equipment, and staff, it is doubtful his suggestions would be sufficient and hard decisions on the receipt of care will have to be made.

Can such decisions be justified? At least one religious and one secular theory of medical ethics allow for this decision making. A Jewish medical ethics specialist discussed this scenario of differential care with COVID. He stated that while a ventilator, for example, could not be removed from one patient to benefit another patient who may have a better chance of survival, a doctor may choose which patient receives a ventilator if both patients need this technology at the same time. Thus, a value may be placed on life.

Implicit is the belief that any means used to deny care are based on some rational foundation, i.e., current scientific knowledge, and that the guidelines changed as the science changed. In this sense, age would not be used for care denial. Rather, the presence of co-morbid conditions, their severity, and number can form a rational basis for a decision.  Though there is an indirect relationship between age and co-morbidities, it would be more likely, but not absolute, that care denial would exist solely for elderly patients. If the criteria used are not capricious but standardized, this would not be age discrimination.

Too, from a Jewish perspective, it is inappropriate to “postpone death.” In an individual with one or more noteworthy co-morbidities and COVID, given current knowledge regarding his/her likelihood to die regardless of life-saving measures, placing this individual on a ventilator may be a violation of this dictum. Even though medical knowledge is not an absolute guarantee of death, it remains the best information available and again, could be used to choose one life over another.

Utilitarian ethics, in this instance, represent the maximization of individual wellbeing within community wellbeing. They can be used to place different values on humans (i.e., based on comorbidities), given finite medical services, and the likelihood that with a poorer prognosis, people’s wellbeing would not be increased. This would not infer that one person was worth less than another, but which patient would best benefit from limited assets.  Although often compared to Nazi practices by people repelled by these theories’ purported inhumanity, they are dissimilar as they are based on rational foundations and not on personal beliefs. If one examines utilitarian ethics dispassionately, they can complement portions of Jewish medical ethics, as discussed in the presented situation.

One could question whether the proximate cause of patient death in these circumstances was a “no care” decision by a physician or whether this decision was an outcome, and the true cause of death was an earlier decision by another individual. That is, was the proximate cause the decision of a family member to visit granddad over the holidays or to enter public spaces on the misguided belief that not wearing a mask was an “individual right”? These venal individuals forget that there is a concomitant responsibility for every right and that rights can be temporarily curtailed, ethically, and legally, in a national emergency. In these instances, I believe that blaming a relative for granddad’s death can be an ethically appropriate response.           

M. Bennet Broner is a medical ethicist.

Image credit: Shutterstock.com

Prev

Medicine must create inclusive clinical trials [PODCAST]

January 7, 2021 Kevin 0
…
Next

The synergy in obesity and cancer

January 8, 2021 Kevin 0
…

Tagged as: COVID, Infectious Disease

Post navigation

< Previous Post
Medicine must create inclusive clinical trials [PODCAST]
Next Post >
The synergy in obesity and cancer

More by M. Bennet Broner, PhD

  • Balancing health care worker immunization and patient safety

    M. Bennet Broner, PhD
  • Navigating the complexity of “first do no harm” in modern medicine

    M. Bennet Broner, PhD
  • The vaccination dilemma: Protecting patient rights or caregiver freedom?

    M. Bennet Broner, PhD

Related Posts

  • COVID exposed this state’s mangled health care system

    Dr. Meg Hansen
  • Health care workers need policy changes, not just applause

    Yuemei (Amy) Zhang, MD
  • Major medical groups back mandatory COVID vaccine for health care workers

    Molly Walker
  • COVID-19 proved that diverse voices make health care better

    Naprisha Taylor
  • The COVID-19 pandemic is a catalyst for reimagining future health care delivery

    Imelda Dacones, MD
  • How social media can help or hurt your health care career

    Health eCareers

More in Policy

  • Pediatricians grapple with guns in America, from Band-Aids to bullets

    Tasia Isbell, MD, MPH
  • Health care wins, losses, and lessons

    Robert Pearl, MD
  • Maximizing care amidst provider shortages: the power of measurement-based care

    Tom Zaubler, MD
  • Unveiling excessive medical billing and greed

    Amol Saxena, DPM, MPH
  • Chronic health issues and homelessness

    Michele Luckenbaugh
  • The impact of certificate of need laws on rural health care

    Jaimie Cavanaugh, JD and Daryl James
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Unraveling the complex enigma of obesity [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physician autonomy and patient interactions in corporate health care

      Michele Luckenbaugh | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Unraveling the complex enigma of obesity [PODCAST]

      The Podcast by KevinMD | Podcast
    • Second chances and simple beauty in thrift stores

      Debbie Moore-Black, RN | Conditions
    • How to facilitate caregiver learning and support to improve clinical care outcomes

      Kerri Milyko, PhD | Tech
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • What Percent of Kids Had Long COVID?
  • Primary Care Visits With NPs, PAs on the Rise; C. Diff in the Intensive Care Unit
  • Are Obesity Drugs for Adolescents Cost-Effective?
  • Lab Tests That Escape FDA Oversight May Come Under Agency Review
  • Fezolinetant Benefits Women Not Suited for Hormone Therapy

Meeting Coverage

  • Fezolinetant Benefits Women Not Suited for Hormone Therapy
  • Plant-Based Estrogen Improves Lipids in Postmenopausal Women
  • New Schizophrenia Treatments Are Coming: Don't Panic
  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Unraveling the complex enigma of obesity [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physician autonomy and patient interactions in corporate health care

      Michele Luckenbaugh | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Unraveling the complex enigma of obesity [PODCAST]

      The Podcast by KevinMD | Podcast
    • Second chances and simple beauty in thrift stores

      Debbie Moore-Black, RN | Conditions
    • How to facilitate caregiver learning and support to improve clinical care outcomes

      Kerri Milyko, PhD | Tech
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The ethics of rationing care during COVID
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...