@article{339b915c710544e7919fdde6086a1484,
title = "Rationing Limited Healthcare Resources in the COVID-19 Era and Beyond: Ethical Considerations Regarding Older Adults",
abstract = "Coronavirus disease 2019 (COVID-19) continues to impact older adults disproportionately with respect to serious consequences ranging from severe illness and hospitalization to increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals and health supplies to address these issues have focused attention on how these resources are ultimately allocated and used. Some strategies, for example, misguidedly use age as an arbitrary criterion that disfavors older adults in resource allocation decisions. This is a companion article to the American Geriatrics Society (AGS) position statement, “Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond.” It is intended to inform stakeholders including hospitals, health systems, and policymakers about ethical considerations that should be considered when developing strategies for allocation of scarce resources during an emergency involving older adults. This review presents the legal and ethical background for the position statement and discusses these issues that informed the development of the AGS positions: (1) age as a determining factor, (2) age as a tiebreaker, (3) criteria with a differential impact on older adults, (4) individual choices and advance directives, (5) racial/ethnic disparities and resource allocation, and (6) scoring systems and their impact on older adults. It also considers the role of advance directives as expressions of individual preferences in pandemics. J Am Geriatr Soc 68:1143–1149, 2020.",
keywords = "COVID-19, ethics, older adult, rationing, triage",
author = "Farrell, {Timothy W.} and Leslie Francis and Teneille Brown and Ferrante, {Lauren E.} and Eric Widera and Ramona Rhodes and Tony Rosen and Ula Hwang and Witt, {Leah J.} and Niranjan Thothala and Liu, {Shan W.} and Vitale, {Caroline A.} and Braun, {Ursula K.} and Caroline Stephens and Debra Saliba",
note = "Funding Information: We wish to acknowledge Nancy Lundebjerg, MPA, CEO of the American Geriatrics Society (AGS), for her editing and input during manuscript preparation. The authors also wish to acknowledge Mary Jordan Samuel, associate director for governance and operations, Dan Trucil, MA, MPH, associate director, communication, and Aimee Cegelka, MA, senior manager of education and special projects, of the AGS, for their assistance with manuscript formatting and submission. The AGS Executive Committee (on behalf of the AGS board), the AGS Ethics Committee, and the chairs of the AGS Ethnogeriatrics and Clinical Practice and Models of Care Committees provided feedback on the manuscript. The following expert reviewers provided feedback on the manuscript: Mary Mulcare, MD, FACEP, and Michael Stern, MD, from the Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital; Chakravarthy Reddy, MD, from the University of Utah School of Medicine and Huntsman Cancer Institute; and Douglas B. White, MD, MAS, from the Department of Critical Care Medicine, University of Pittsburgh, and Program on Ethics and Decision Making in Critical Illness. Tony Rosen, MD, MPH, appreciates the generosity of the Razak family in allowing him to live in their home during the COVID-19 pandemic. Timothy W. Farrell, MD, AGSF, dedicates this manuscript to the memory of Bernard Gert, PhD. Participation by Lauren E. Ferrante (K76AGS057023), Tony Rosen (K76AG054866), and Caroline Stephens (K76AG054862) was supported by Paul B. Beeson Emerging Leaders in Aging Career Development Awards from the National Institute on Aging. Leah J. Witt's (K01HP33446) participation was supported by a Geriatrics Academic Career Award from the Health Resources and Services Administration (HRSA), an operating division of the U.S. Department of Health and Human Services. The authors have declared no conflicts of interest for this article. Concept and design: Farrell, Francis, Brown, Ferrante, Widera, Rhodes, Vitale, and Saliba. Analysis and interpretation of data: All authors. Manuscript preparation: Farrell, Francis, Brown, Ferrante, and Saliba. Funding Information: Participation by Lauren E. Ferrante (K76AGS057023), Tony Rosen (K76AG054866), and Caroline Stephens (K76AG054862) was supported by Paul B. Beeson Emerging Leaders in Aging Career Development Awards from the National Institute on Aging. Leah J. Witt's (K01HP33446) participation was supported by a Geriatrics Academic Career Award from the Health Resources and Services Administration (HRSA), an operating division of the U.S. Department of Health and Human Services. Publisher Copyright: {\textcopyright} 2020 The American Geriatrics Society",
year = "2020",
month = jun,
day = "1",
doi = "10.1111/jgs.16539",
language = "English",
volume = "68",
pages = "1143--1149",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "6",
}