As COVID-19 response create financial pressures in hospitals, the ethics of proper resource planning take a central position. Any hospital management aims are to allocate resources fairly, but unfortunately, determination of what is “fair” is an issue of debate. The need for healthcare services surpasses affordable provision by health care systems across the world, making resource allocation considerations vital. Resource allocation becomes an ethical issue, as its application involves matters of justice (Emmanuel et al., 2020). It is in every stakeholder’s interest to apply ethical decision making in every situation as it shows consideration for the interest of those affected by the decisions.
The increasing number of COVID-19 patients is also increasing the number of patients who need intensive care and ventilator support. When the number of patients who require care exceeds the provisioned capacity of healthcare systems, health care professionals will face a legal dilemma of healthcare rationing. Doctors in the United States could be charged in courts for rationing health care. Treating every patient is a matter of ethics and law, even where survival chances appear uncertain (Emmanuel et al., 2020). However, in a pandemic situation, health care professionals could consider applying the principles behind triage and prioritize patient care to those who have the highest odds of surviving. The questions to answer are; what is fair resource allocation? Is healthcare rationing justifiable?
Ethics of Random Allocation
The COVID-19 pandemic is resulting in an unprecedented demand for health care, particularly critical care. The increase in demand is forcing health care providers to change staffing models raising the ethical concern of placing some staff in unfamiliar fields. Health care facilities are creating specialized roles such as ‘intubating teams’ and other personnel being relocated from clinical specialties in other departments to the acute care setting. Health care professionals are placed to deliver interventions in care settings that pose a significant risk of contracting COVID-19. The risk is high in acute care as critically ill patients carry the most concentrated particles.
In a pandemic scenario, the question of whether the ‘obligation to treat’ is enough consideration to require health care professionals to discharge their duties even when doing so presents a considerable risk of harm to them. To the obligation to treat, health care providers must be flexible as it may require them to work in locations outside their regular practice. The necessity for redeployment or harm avoided must be analysed carefully and communicated clearly to those affected by the changes (Mannelli, 2020). A prioritization exercise is ethically essential because it is likely to impact patient care in other areas not related to COVID-19. Health care planners should answer two questions; do health care professionals have a duty to treat COVID-19 patients? Does the obligation to treat override the safety of health care workers?
Ethics of Decision and Priority Resource Access
Investments in health care systems aim to reduce or eliminate public health risks. However, some health risks are more significant than others, and resource allocation must respond to these risks. The process of resource allocation may also determine who faces the risk. The efficiency brought about by resource allocation is not only of economic importance but also of ethical importance. A more efficient health care system means it can deliver more health care benefits per dollar invested compared to the less efficient system (Emmanuel et al., 2020). First responders and health care workers in a pandemic can justifiably be prioritized when allocating resources because of their contribution to the entire process of fighting the health pandemic.
Although the principle of first come, first served is primarily applicable in allocating health care resources, the principle may not be appropriate in a pandemic scenario. In practice, it is highly likely to allocate more resources to the most vulnerable populations (Mannelli, 2020). When administering vaccines, younger populations who might be at the lowest risk should have low priority, but if they become sick, then the situation changes. Balancing utility and the principle of priority should be considered. Providing resources to the benefit of many people may sometimes exclude those at the highest risk. Two fundamental questions in this aspect are; should priority be given to the worst of the population? And, what costs are essential in cost-effectiveness analysis?