What are the guiding principles being discussed regarding prioritization of limited resources to younger patients?

Bottom Line:

Principles guiding prioritization of limited resources to younger patients during the COVID-19 pandemic are discussed. 

Reference:

Archard, D. & Caplan, A. Is it wrong to prioritize younger patients with covid-19? BMJ (2020). https://doi.org/10.1136/bmj.m1509

Date Published: 

22 April 2020 

Synopsis:

The principles guiding resource reallocation have been recently brought to public attention by the currently over-burdened state of healthcare systems. There have been reports of using age as a criterion for intensive care resources in response to the COVID-19 pandemic by a few countries including Italy. Arguments made for and against this notion are presented here. There is precedence in considering age in addressing ethical dilemmas and clinical decision-making (organ transplant lists). Age alone is also often not the deciding factor, but rather contributes to a myriad of variables. Further, the “fair winnings” argument holds the principle of giving equal opportunity to life to prioritize younger patients. The association of increasing age and morbidity is also emphasized to support resource reallocation and the goal of maximizing the number of lives saved. Conversely, the argument against age-based measures is made. Relevant discussions will ultimately lead to the ethical dilemma of choosing an age threshold for dichotomous decision-making. The “fair winnings” argument is also criticized for assuming length of age as an accurate proxy for fairness at life as many life-altering and -shortening events can occur and cannot be predicted. Lastly, implementing age-based policies may have greater implications in societies and propagate the notion of under-valuing aging populations. To conclude, prioritizing younger patients is an important and complex clinical question that concerns current healthcare systems.

Summary by: Julia Kim