This article is a companion manuscript to the American Geriatrics Society (AGS) official position statement on resource allocation strategies and age-related considerations, developed by the AGS Ethics Committee in collaboration with others.
The AGS position statement relies on a view o distributive justice designed to maximize the relevance of clinical factors and deemphasize disproportionate consideration of age. In making decisions to allocate scarce resources, the AGS position includes:
- Avoiding use of age as a categorical exclusion from resource allocation and avoiding use of age-based cutoffs
- Assessing co-morbidities with appropriate consideration of the disparate impact of social determinant of health
- Encouraging decision-makers to focus on in-hospital survival and short-term mortality (less than 6 months) outcomes, rather than longer-term outcomes
- Avoiding consideration of criteria such as life-years saved or long-term predicted life expectancy (which may disadvantage older persons)
- Forming and staffing triage committees who have no direct clinical role in care of patients being considered for resource allocation and tasking these officers and committees with allocation decisions
- Developing institutional allocation strategies that are transparent, uniformly applied, and developed with input from multiple disciplines
- Facilitating appropriate advance care planning based on individual patients’ values, preferences, and goals.
The AGS position is in part a response to the inclusion of age as a criterion in some existing resource allocation strategies, which may unjustly disfavor older adults during a public health emergency. It also considers the impact of legal obligations and prohibitions against discrimination under the Affordable Care Act and the Age Discrimination Act.