This article is a companion article to the American Geriatrics Society (AGS) position statement, “Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond”. It describes the legal and ethical background for the position statement and seeks to inform hospitals, health systems, and policy makers about ethical considerations for the allocation of resources to older adults during an emergency.
- Health care workers need just frameworks from policy makers to help guide decisions about resource allocation during the pandemic.
- Using age alone as an exclusion factor for certain types of treatment such as ventilators or ICU care ignores many other indicators of overall health such as functional status, cognitive status, or pre-existing conditions.
- Strategies that use age as a primary factor to inform resource allocation disproportionately impact older adults and impose a greater risk of disparate impacts on racial and ethnic minorities who are being disproportionately affected by COVID-19.
- There are frameworks that do not take age into account such as the SOFA score or the multi-principal allocation framework endorsed by the Commonwealth of Pennsylvania.
- Age or potentially saved life-years could be used as a “tiebreaker” or secondary factor in allocation of resources.
- Greater emphasis should be placed on having advance care planning completed for older adults before they are in crisis but these conversations should not be confused with resource allocation or subtly hint or coerce patients into considering the need for resource conservation.
Summary authored by Daniel Chimitt with edits by Jennifer Carnahan, MD, MPH, MA