Ethical Issues and the Allocation of Scarce Resources During a Public Health Emergency
Authors: Michael D. Christian, Christian E. Sandrock, Asha Devereaux, James Geiling, Dennis E. Amundson, Lewis Rubinson
Journal: Annals of Internal Medicine (2009)

Letters16 June 2009Ethical Issues and the Allocation of Scarce Resources During a Public Health EmergencyMichael D. Christian, MD, Christian E. Sandrock, MD, MPH, Asha Devereaux, MD, MPH, James Geiling, MD, Dennis E. Amundson, MC, USN, and Lewis Rubinson, MD, PhDMichael D. Christian, MDFrom Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada; University of California, Davis, School of Medicine, Sacramento, CA 95817; Coronado, CA 92118; Veterans Affairs Medical Center, White River Junction, VT 05009; Naval Medical Center San Diego, San Diego, CA 92134; and Harborview Medical Center, University of Washington, Seattle, WA 98104.Search for more papers by this author, Christian E. Sandrock, MD, MPHFrom Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada; University of California, Davis, School of Medicine, Sacramento, CA 95817; Coronado, CA 92118; Veterans Affairs Medical Center, White River Junction, VT 05009; Naval Medical Center San Diego, San Diego, CA 92134; and Harborview Medical Center, University of Washington, Seattle, WA 98104.Search for more papers by this author, Asha Devereaux, MD, MPHFrom Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada; University of California, Davis, School of Medicine, Sacramento, CA 95817; Coronado, CA 92118; Veterans Affairs Medical Center, White River Junction, VT 05009; Naval Medical Center San Diego, San Diego, CA 92134; and Harborview Medical Center, University of Washington, Seattle, WA 98104.Search for more papers by this author, James Geiling, MDFrom Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada; University of California, Davis, School of Medicine, Sacramento, CA 95817; Coronado, CA 92118; Veterans Affairs Medical Center, White River Junction, VT 05009; Naval Medical Center San Diego, San Diego, CA 92134; and Harborview Medical Center, University of Washington, Seattle, WA 98104.Search for more papers by this author, Dennis E. Amundson, MC, USNFrom Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada; University of California, Davis, School of Medicine, Sacramento, CA 95817; Coronado, CA 92118; Veterans Affairs Medical Center, White River Junction, VT 05009; Naval Medical Center San Diego, San Diego, CA 92134; and Harborview Medical Center, University of Washington, Seattle, WA 98104.Search for more papers by this author, and Lewis Rubinson, MD, PhDFrom Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada; University of California, Davis, School of Medicine, Sacramento, CA 95817; Coronado, CA 92118; Veterans Affairs Medical Center, White River Junction, VT 05009; Naval Medical Center San Diego, San Diego, CA 92134; and Harborview Medical Center, University of Washington, Seattle, WA 98104.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-12-200906160-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The perfect tertiary triage protocol for a pandemic or mass casualty event has not yet been published. We welcome and congratulate White and colleagues (1) on their contribution to the ongoing dialogue related to tertiary triage. However, just as triage is always a balance between available resources and demand, one must also attempt to strike the right balance among ethical doctrine, evidence, usability, and functionality when developing a triage score. The triage score proposed by White and colleagues leans in favor of addressing the issues most important in the conceptual world of ethics at the expense of ...References1. White DB, Katz MH, Luce JM, Lo B. Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions. Ann Intern Med. 2009;150:132-8. [PMID: 19153413] LinkGoogle Scholar2. Christian MD, Hawryluck L, Wax RS, Cook T, Lazar NM, Herridge MS, et al. Development of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006;175:1377-81. [PMID: 17116904] CrossrefMedlineGoogle Scholar3. Devereaux AV, Dichter JR, Christian MD, Dubler NN, Sandrock CE, Hick JL, et al; Task Force for Mass Critical Care. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest. 2008;133:51S-66S. [PMID: 18460506] CrossrefMedlineGoogle Scholar4. Rubinson L, Hick JL, Hanfling DG, Devereaux AV, Dichter JR, Christian MD, et al; Task Force for Mass Critical Care. Definitive care for the critically ill during a disaster: a framework for optimizing critical care surge capacity: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest. 2008;133:18S-31S. [PMID: 18460504] CrossrefMedlineGoogle Scholar5. Burkle FM. Mass casualty management of a large-scale bioterrorist event: an epidemiological approach that shapes triage decisions. Emerg Med Clin North Am. 2002;20:409-36. [PMID: 12132490] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Michael D. Christian, MD; Christian E. Sandrock, MD, MPH; Asha Devereaux, MD, MPH; James Geiling, MD; Dennis E. Amundson, MC, USN; Lewis Rubinson, MD, PhDAffiliations: From Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada; University of California, Davis, School of Medicine, Sacramento, CA 95817; Coronado, CA 92118; Veterans Affairs Medical Center, White River Junction, VT 05009; Naval Medical Center San Diego, San Diego, CA 92134; and Harborview Medical Center, University of Washington, Seattle, WA 98104.Note: The opinions expressed are those of the authors and do not necessarily reflect those of the Department of Veterans Affairs or the U.S. Government.Disclosures: All authors are members of the American College of Chest Physicians Task Force on Mass Critical Care. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoWho Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions Douglas B. White , Mitchell H. Katz , John M. Luce , and Bernard Lo Ethical Issues and the Allocation of Scarce Resources During a Public Health Emergency Douglas B. White , Bernard Lo , and Mitch Katz Ethical Issues and the Allocation of Scarce Resources During a Public Health Emergency Allan R. Glass Ethical Issues and the Allocation of Scarce Resources During a Public Health Emergency John Hansen-Flaschen Ethical Issues and the Allocation of Scarce Resources During a Public Health Emergency Mark D. Siegel Ethical Issues and the Allocation of Scarce Resources During a Public Health Emergency Tia Powell , Guthrie Birkhead , and Kelly Christ Metrics Cited byQuality management of patient careIntensive care unit triageA Modified Sequential Organ Failure Assessment Score for Critical Care Triage 16 June 2009Volume 150, Issue 12Page: 890-891KeywordsConflicts of interestCritical careIntensive care unitsLife expectancyPrevention, policy, and public healthReasoningThoraxTriageVentilatorsVeteran care ePublished: 16 June 2009 Issue Published: 16 June 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...