This article evaluates potential strategies for allocation of scarce PPE to health care providers from an ethical perspective and recommends a range of approaches to be adapted to the circumstances of a particular hospital.
Many ethical frameworks focus on the equitable distribution of scarce resources to patients, but this article addresses the comparatively unanticipated scarcity of personal protective equipment and how to allocate these resources for health care providers responding to the COVID-19 pandemic. The authors stipulate that these measures should only apply when adequate PE is not available and patients must be treated and that any such rationing measures must be limited in duration. They also emphasize the importance of procedural justice and the need for leaders to provide guidance and establish policy rather than leave clinicians to fend for themselves or rely on the default first-come, first-served approach.
The article identifies two allocation approaches under a utilitarian framework, one focused on consequences to clinicians and another on overall benefit to patients. Under the first approach, PPE are distributed to protect the greatest number of clinicians. This may include using the least protection necessary for a given setting, limiting procedures that are to be performed, and avoiding unnecessary staff in settings where PPE is required. The second approach focuses on protecting clinicians able to do the most good for the greatest number of patients, but the authors note that this is at best a difficult determination and one certain to cause moral distress.
Other approaches for prioritization assessed in the article include using social worth (instrumental value provided by the clinician in providing patient care during and after the pandemic), reciprocity (benefit in exchange for risk undertaken), and protection of vulnerable clinicians (based on intrinsic factors such as immunosuppressed status, pregnancy, or significant comorbidities).
The authors conclude that any of the above approaches, including hybrid approaches combining criteria, may be appropriate for some clinical settings. However, they also conclude that there are other criteria that are unacceptable, specifically: a first-come, first-served policy; a system based organizational seniority or position; or polices are based on a clinician’s economic value, race, ethnicity, sexual orientation, or gender.