This forthcoming article reviews public health emergency principles of disaster planning and resource stewardship from the bioethical perspective with a focus on relevance for COVID-19 and future crises. In particular, the article focuses on pediatric populations and guidance for pediatric clinicians.
Implementation of CSC when health care systems are overwhelmed increases the ability to provide appropriate care to all patients to the extent possible under the circumstances, and local, state, and regional consensus on procedures and standards is desirable to facilitate coordination and consistency. However, several states lack publicly available guidance for CSC implementation to assist hospitals in adopting triage protocols simultaneously. De-prioritization of elective and non-urgent medical care to conserve scarce resources may create conflict with institutional commitment to provide some services, but institutions must remain mindful of the needs of the regions they serve and the need for specialized care among some patients who do not have COVID-19.
The article explores the utility and challenges of illness severity scoring systems, including their potential impact on health disparities. Seemingly objective criteria may exacerbate the effects of existing health inequities between populations if the approach overlooks social determinants of health. Protocols will necessary vary, and no single approach can incorporate every applicable moral consideration, but the authors argue that relevant frameworks include likelihood of benefit, greatest need, amount of resource required, persons carrying out vital functions, and random allocation.
With respect to pediatric populations, the authors note that, while several ethical arguments can be made in support of prioritization of younger patients, these arguments are less persuasive regarding a disease like COVID-19 that has disproportionate morbidity and mortality effects on older patients. Existing scoring approaches for allocation are also challenging to apply consistently across adult and pediatric populations.