Review: Rationing limited health care resources in the COVID-19 era and beyond: Ethical considerations regarding older adults

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.

|2020-05-08T11:55:13-04:00May 8th, 2020|COVID-19 Literature|Comments Off on Review: Rationing limited health care resources in the COVID-19 era and beyond: Ethical considerations regarding older adults

About the Author: Daniel Orenstein

Daniel Orenstein
Daniel G. Orenstein, JD, MPH, is Visiting Assistant Professor of Law at the Indiana University Robert H. McKinney School of Law in Indianapolis. He teaches in the areas of administrative law, public health law, and health care law and policy. His research focuses on public health law, policy, and ethics, and he was previously Deputy Director of the Network for Public Health Law Western Region, where much of his work centered on emergency preparedness and response, including resource allocation and government authority during declared emergencies, as well as vaccination policy.

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