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Ethics Statement on Resource Allocation in a Pandemic

Disclaimer: This committee resource is provided for informational purposes only and does not represent medical or legal advice. It has not been approved by ASA’s Board of Directors or House of Delegates and does not represent an ASA Policy, Statement or Guideline.

Allocation of scarce medical resources may become a reality during pandemic situations. No individual healthcare provider should be required to make triage decisions in time of resource scarcity. It is crucial that all institutions have clear guidelines in place before such a crisis occurs.

Many excellent resources already exist addressing the ethics of resource allocation in  times of scarcity such as war and/or pandemics. (A partial list is attached.) The ASA would like to offer some guidance to our members during this crisis.

Institutions are responsible for developing their own policies concerning crisis situations with clear criteria for allocation of resources such as medications and ventilators.  Transparency about how these resources are allocated should be included in the policy.

Components of the institutional policy/guideline should ensure that:

  • An individual anesthesiologist/physician/provider should not be required to make decisions on resource allocation and triage. The decisions on the criteria for resource allocation should be made during crisis preparations and if necessary, enforced by a triage officer or committee.
  • Protection of healthcare personnel should be paramount; this ensures adequate supplies of personal protective equipment (PPE) and defining if there is a duty to treat if proper PPE is not available.
  • Care for healthcare workers and those putting themselves in harm’s way should be prioritized.
  • Consideration should be given to protecting health care workers with the highest risk of mortality should they contract COVID-19, including, where feasible, excusing them from caring for COVID-19 patients.
  • Anesthesiologists should push their institutions to develop these criteria as soon as possible.

Ethical Resources During the COVID-19 Pandemic

General articles

Ethical Framework for Health Care Institutions & Guidelines for Institutional Ethics Services Responding to the Coronavirus Pandemic. The Hastings Center. March 16, 2020.  (Accessed Mar. 24,2020)

Google Drive with multiple COVID-19 papers/resources

On rationing and allocation of scarce resources

Christian MD, Hawryluck L, Wax RS, et al. Development of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006;175(11):1377-1381. doi:10.1503/cmaj.060911

Emanuel, EJ et al. Fair Allocation of Scarce Medical Resources in the Time of COVID-19. NEJM. Published online March 23, 2020. (Accessed Mar. 24, 2020) 

Meeting the Challenge of Pandemic Influenza: Ethical Guidance for Leaders and Health Care Professionals in the Veterans Health Administration.  (Accessed Mar. 24, 2020) 

New York State Task Force on Life and the Law, New York State Department of Health. Ventilator Allocation Guidelines. November 2015. (Accessed Mar. 24, 2020). 

Nurok M. “Rethinking ICU Allocation In Times Of Crisis." Health Affairs Blog, March 30, 2021. DOI: 10.1377/hblog20210324.224366.

Swiss Academy Of Medical Sciences. COVID-19 pandemic: triage for intensive-care treatment under resource scarcity. Swiss Med Wkly. 2020 Mar 24;150:w20229. doi: 10.4414/smw.2020.20229. PMID: 32208495.

White DB. A Model Hospital Policy for Allocating Scarce Critical Care Resources. University of Pittsburgh School of Medicine. Published March 23, 2020. Accessed March 31, 2020.

White DB, Lo B. A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic. JAMA. Published online March 27, 2020. doi:10.1001/jama.2020.5046. 

On the duty to protect health care workers as they serve

Emanuel, EJ et al. Fair Allocation of Scarce Medical Resources in the Time of COVID-19. NEJM. Published online March 23, 2020. (Accessed Mar. 24, 2020)

Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement, 2014.  (Accessed Mar. 24, 2020)

On the role of Fellows, Residents, Medical Students, older workers and others who may be at increased risk

ACGME Resident/Fellow Education and Training Considerations related to Coronavirus (COVID-19). ACGME Mar. 11, 2020 statement.  (Accessed Mar. 24, 2020)

Global COVID-19 Case Fatality Rates, Center for Evidence Based Medicine, University of Oxford. Mar. 23, 2020.  (Accessed Mar. 24, 2020)

On the duty of physicians and other health care workers to serve

Feudtner C, Should I Stay or Should I Go?  The Physician in Time of Crisis, Commentary 1. Virtual Mentor. 2006; 8(4):208-212.  (Accessed Mar. 24, 2020)

Schwartz AR, Doubtful Duty: Physician’s Legal Obligation to Treat During an Epidemic. Stanford Law Review, Nov. 2007. (Accessed Mar. 24, 2020)

Wadleigh J. Should I Stay or Should I Go? The Physician in Time of Crisis, Commentary 2. Virtual Mentor. 2006;8(4):212-213. (Accessed Mar. 24, 2020)

On talking to patients regarding Coronavirus and their decisions

Covid Ready Communication Skills. Center to Advance Palliative Care.   (Accessed Mar. 24, 2020)

Respecting Choices-Person Centered Care. (Accessed Mar. 24, 2020)

Curtis JR, Kross EK, Stapleton RD. The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19). JAMA. Published online March 27, 2020. doi:10.1001/jama.2020.4894.

World Health Organization

Ethics in epidemics, emergencies and disasters: Research, surveillance and patient care.