The editorial argues that the fairest approach to crisis triage and allocation of scarce resources requires use of clinical criteria applied to individualized patient assessment of likely recover, and not assumptions that favor or disfavor groups.
The authors argue that universal do-not-resuscitate (DNR) orders for all patients with a particular diagnosis (e.g., COVID-19) contravene the physician’s obligation to avoid harm, act in the patient’s best interests, and respect the value of each individual. A careful balancing of likely burdens and possible benefits of the intervention is necessary, and this is not consistent with a blanket approach. The authors also oppose consideration of social worth in rationing decisions as ethically indefensible. Resource allocation decisions must appreciate the value and dignity of every individual, reflect appropriate humility, and acknowledge that social factors limit opportunity for many persons.
The authors object to the promotion of a “life-years,” “life-cycle,” or “fair innings” approach that prioritizes patients based on anticipated life expectancy, arguing that such approaches systematically disfavor older patients, disabled patients, and other groups. While these approaches have gained traction recently, the authors argue for the need to provide an individualized assessment of medical need, prognosis, and likely effectiveness of treatment.