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A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic

Educational Objective
To understand ethical challenges in rationing ventilators and critical care beds.
1 Credit CME

As the coronavirus disease 2019 (COVID-19) pandemic intensifies, shortages of ventilators have occurred in Italy and are likely imminent in parts of the US. In ordinary clinical circumstances, all patients in need of mechanical ventilation because of potentially-reversible conditions receive it, unless they or their surrogates decline. However, there are mounting concerns in many countries that this will not be possible and that patients who otherwise would likely survive if they received ventilator support will die because no ventilator is available. In this type of public health emergency, the ethical obligation of physicians to prioritize the well-being of individual patients may be overridden by public health policies that prioritize doing the greatest good for the greatest number of patients.1 These circumstances raise a critical question: when demand for ventilators and other intensive treatments far outstrips the supply, what criteria should guide these rationing decisions?

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Article Information

Corresponding Author: Douglas B. White, MD, MAS, Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St, Scaife Hall, Room 608, Pittsburgh, PA 15261 (douglas.white@pitt.edu).

Published Online: March 27, 2020. doi:10.1001/jama.2020.5046

Funding/Support: This work was funded by National Institutes of Health–National Heart, Lung, and Blood Institute grant K24HL148314 (Dr White).

Role of the Funder/Sponsor: The National Heart, Lung, and Blood Institute had no role in the preparation, review, or approval of the manuscript and the decision to submit the manuscript for publication.

Conflict of Interest Disclosures: None reported.

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