Author + information
- Received April 10, 2020
- Revision received April 30, 2020
- Accepted May 4, 2020
- Published online June 29, 2020.
- James N. Kirkpatrick, MDa,∗ (, )@Kirkpatj,
- Sarah C. Hull, MD, MBEb,
- Savitri Fedson, MD, MAc,
- Brendan Mullen, BSFSd and
- Sarah J. Goodlin, MDe
- aDivision of Cardiology and Department of Bioethics and Humanities, University of Washington, Seattle, Washington
- bSection of Cardiovascular Medicine, Program for Biomedical Ethics, Yale University, New Haven, Connecticut
- cCenter for Medical Ethics and Health Policy, Baylor College of Medicine, Section of Cardiology, Michael E DeBakey VA Medical Center, Houston, Texas
- dAmerican College of Cardiology, Washington, DC
- eDepartment of Geriatrics and Palliative Medicine, VAPORHCS, Oregon Health Sciences University, Patient-Centered Education and Research, Portland, Oregon
- ↵∗Address for correspondence:
Dr. James N. Kirkpatrick, Heart Institute, University of Washington, 1959 Pacific Street, Seattle, Washington 98195.
• Difficult decisions about triage and allocation have arisen in the COVID-19 pandemic.
• In a crisis, autonomy may become subordinate to maximize the number of lives saved.
• Fairness involves equal access to scarce resources, ignoring factors unrelated to prognosis and maximizing benefit.
• Transparent communication and palliative care are central to providing the best possible care to patients.
The COVID-19 pandemic and its sequelae have created scenarios of scarce medical resources, leading to the prospect that health care systems have faced or will face difficult decisions about triage, allocation, and reallocation. These decisions should be guided by ethical principles and values, should not be made before crisis standards have been declared by authorities, and, in most cases, will not be made by bedside clinicians. Do not attempt resuscitation and withholding and withdrawing decisions should be made according to standard determination of medical appropriateness and futility, but there are unique considerations during a pandemic. Transparent and clear communication is crucial, coupled with dedication to provide the best possible care to patients, including palliative care. As medical knowledge about COVID-19 grows, more will be known about prognostic factors that can guide these difficult decisions.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received April 10, 2020.
- Revision received April 30, 2020.
- Accepted May 4, 2020.
- 2020 American College of Cardiology Foundation
- Central Illustration
- Principles and Values for Allocation of Scarce Medical Resources
- Contingency Versus Crisis: Not to be Confused
- Resuscitation Decisions
- Withholding and/or Withdrawing Life-Sustaining Therapies
- Advance Care Planning
- Fiduciary Duties in Crisis