The authors of this Hastings Center Report explain how ethical and legal duties intersect with public health in a time of crisis.
When the health system can no longer handle the needs of all persons seeking care, ethical and legal principles inform an approach to appropriately allocating scarce health goods and services and ensuring that marginalized populations are treated fairly.
The report discusses various ethical and legal dimensions of COVID-19 response, including the allocation of scarce resources. Every effort should be made to avoid resource scarcity; however, during a public health emergency the standard of care may shift from the ordinary standard emphasizing the needs of an individual patient to “crisis standards of care,” which emphasizes the needs of the community. Even under crisis standards of care, patients should continue to receive the optimal level of care that can be delivered under the circumstances. An ethical allocation of resources may begin with prioritization of critical health workers to ensure continued response capacity within the health system. In addition, the authors recommend that testing and treatment decisions center on prevention of disease transmission, protection of those at highest risk, meeting societal needs, and promoting social justice. These ethical principles balance and supplement strictly clinical considerations as part of a fair framework for resource allocation. Relevant approaches may include prioritizing resources for persons in confined settings, areas experiencing localized outbreaks, persons with conditions that put them at highest risk, and persons who supply critical services, but any approach must also appropriately address the needs of poorer and marginalized populations to ensure fair distribution of resources.