Amid the current pandemic, one of the biggest challenges in hospitals is the shortage of medical equipment, specifically ventilators. Ventilators are machines that assist with mechanical breathing in the case of respiratory failure, which is a common symptom of COVID-19.
According to a CNN interview with Dr. Anthony Fauci, there were around 12,700 ventilators in the U.S. National Strategic Stockpile as of March 2020. However, Dr. Fauci warned that if the U.S. failed to effectively flatten the curve, this stockpile could easily be depleted, forcing doctors to make critical decisions regarding life and death.
To combat this shortage, there have been several initiatives. Companies such as General Motors, Ford and Tesla are devoting some of their manufacturing plants for the manufacturing of ventilators. Additionally, 3D printer enthusiasts have designed valves that could allow two patients to use one ventilator at the same time. However, even with these solutions, the pandemic continued to escalate, and hospitals were continuously overwhelmed with patients.
Ultimately, healthcare providers had to turn to a more immediate solution: ventilator rationing. Most medical rationing guidelines, even beyond ventilator rationing, follow the same basic rule — the resource should go to the patient that has the highest chance of surviving the longest after treatment. However, these guidelines can have biases that implicitly discriminate against patients who have higher rates of health disparities due to structural racism and medical discrimination.
According to the World Health Organization’s (WHO) COVID-19 resource allocation guidelines, care and medical equipment should go to those who benefit the most, which is defined by the best clinical outcome and the greatest medical need. The WHO guidelines also explicitly state that “irrelevant characteristics of populations within countries, such as ethnicity, race or creed, should play no role in any resource allocation in any pandemic.”
Outside the pandemic, similar guidelines are followed by the United Network for Organ Sharing (UNOS). In transplants, medical criteria — such as if the organ is a match for the patient and if the transplant team deems the organ acceptable for the patient — are used for organ allocation. Like the WHO guidelines for COVID-19, age, sex, ethnicity and socioeconomic status are not considered in organ transplantation. While these resource allocation guidelines do make an effort to honor their commitment to “treating people with equal respect,” these guidelines have the potential to be discriminatory when determining which patient to prioritize.
According to the Collaborative on Health and the Environment, the “blind” approach to resource allocation doesn’t account for the health disparities that patients face because of their race, ethnicity, abilities, gender and socioeconomic status. For example, those living in lower socioeconomic areas are more likely to live in environments that have a higher risk for pollution, stress and injury — all of which contribute to more long-term health effects like respiratory problems. According to an article published in the New England Journal of Medicine, healthcare workers are more likely to disregard the pain and symptoms a black patient is feeling, which perpetuates medical discrimination, worsens current illnesses, and can increase the risks of developing future health conditions.
Additionally, according to the Centers for Disease Control and Prevention, the leading cause of uninsurance is the lack of affordability. Patients in minority or lower socioeconomic communities have restricted access to healthcare due to lack of health coverage.
Ultimately, the “blind” allocation system discriminates against patients who face certain social determinants of health, health disparities and medical racism, because these factors all contribute to increased risks of developing pre-existing health conditions like high blood pressure and diabetes. Such pre-existing health conditions would put these patients at a lower priority for receiving the ventilator or any other life-saving medical resource.
Ventilator rationing has brought up many questions on how medical supplies are generally distributed during a shortage. Potential solutions include revising resource allocation guidelines so that they recognize the barriers to healthcare and structural issues that some patients may face. As the pandemic continues to progress and these issues continue to be highlighted, many scientists and medical professionals have called for these guidelines to be re-examined. These discussions could bring together officials from not only the medical field, but a diverse selection of fields on how to make healthcare more holistic.