ArticleJournal of medical ethics2022
Rationing, racism and justice: advancing the debate around 'colourblind' COVID-19 ventilator allocation.
Article in Journal of medical ethics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed.
- Age and Saving Lives in Crisis Standards of Care: A Multicenter Cohort Study of Triage Score Prognostic Accuracy.Critical care explorations · 2025Observational
- The role of social justice in triage revisited: a threshold conception.Medicine, health care, and philosophy · 2025Review
- Medical rationing choices of laypeople and clinicians are often illogical and inconsistent with their own stated preferences.PloS one · 2025Article
- COVID-19 critical care triage across Canada: a narrative synthesis and ethical analysis of early provincial triage protocols.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2024Article
- Rationing, Responsibility, and Vaccination during COVID-19: A Conceptual Map.The American journal of bioethics : AJOB · 2024Article
- COVID-19 ethics: unique aspects and a review as of early 2024.Monash bioethics review · 2024Review
- Investigating Ethical Tradeoffs in Crisis Standards of Care through Simulation of Ventilator Allocation Protocols.medRxiv : the preprint server for health sciences · 2024Article
- Investigating ethical tradeoffs in crisis standards of care through simulation of ventilator allocation protocols.PloS one · 2024Article
- Simulation of New York City's Ventilator Allocation Guideline During the Spring 2020 COVID-19 Surge.JAMA network open · 2023Article
- Validation of a specialized evaluation system for COVID-19 in Japan: A retrospective, multicenter cohort study.Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy · 2023Article
- Rationing scarce healthcare capacity: A study of the ventilator allocation guidelines during the COVID-19 pandemic.Production and operations management · 2023Article
- Race and resource allocation: an online survey of US and UK adults' attitudes toward COVID-19 ventilator and vaccine distribution.BMJ open · 2022Article
- Racial and Ethnic Disparities in Hospitalization and Clinical Outcomes Among Patients with COVID-19.The western journal of emergency medicine · 2022Article
- Assessment of a Crisis Standards of Care Scoring System for Resource Prioritization and Estimated Excess Mortality by Race, Ethnicity, and Socially Vulnerable Area During a Regional Surge in COVID-19.JAMA network open · 2022Article
- Promoting equity with a multi-principle framework to allocate scarce ICU resources.Journal of medical ethics · 2022Article
- Ethics of Extracorporeal Membrane Oxygenation under Conventional and Crisis Standards of Care.The Journal of clinical ethics · 2022Article
- The Treatment of Disability under Crisis Standards of Care: An Empirical and Normative Analysis of Change over Time during COVID-19.Journal of health politics, policy and law · 2021Article
- Protecting our Elders and Developing Equitable Policies During Public Health Emergencies: Ethical Recommendations.Current geriatrics reports · 2021Review
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Abstract
Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities-who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey's Crisis Standard of Care policy, we describe how dominant rationing guidance compounds for many Black patients prior unfair structural disadvantage, chiefly due to the way creatinine and life expectancy are typically considered.We outline six possible policy options towards a more just approach: improving diversity in decision processes, adjusting creatinine scores, replacing creatinine, dropping creatinine, finding alternative measures, adding equity weights and rejecting the dominant model altogether. We also contrast these options with making no changes, which is not a neutral default, but in separate need of justification, despite a prominent claim that it is simply based on 'objective medical knowledge'. In the regrettable absence of fair federal guidance, hospital and state-level policymakers should reflect on which of these, or further options, seem feasible and justifiable.Irrespective of which approach is taken, all guidance should be supplemented with a monitoring and reporting requirement on possible disparate impacts. The hope that we will be able to continue to avoid rationing ventilators must not stand in the way of revising guidance in a way that better promotes health equity and racial justice, both to be prepared, and given the significant expressive value of ventilator guidance.
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