On March 28, 2020, the “Rapid Expert Consultation on Crisis Standards of Care for the COVID-19 Pandemic (March 28, 2020) (2020)” was issued: “the aim of this rapid expert consultation is to articulate the guiding principles, key elements, and core messages that undergird Crisis Standards of Care decision-making at all levels.”
Crisis Standards of Care (CSC) are applied when a pervasive or catastrophic disaster make it impossible to meet usual healthcare standards. CSC compel thinking in terms of what is best for an entire group of patients, on the principle of saving the most lives (or achieving the best outcome for the group of patients) rather than focusing only on an individual patient under medical care: “When equipment, staffing, and material are sufficient, focusing only on what is best for each individual patient is tantamount to the best outcome for the collection of patients because the group outcome is simply the sum of the individual outcomes. Under conditions that compel Crisis Standards of Care, this identity of outcomes for the individual and group breaks down, and the decision makers cannot avoid the hard choices before them.”
“Despite efforts to forestall the spread of SARS-CoV-2 to date, it appears that the COVID-19 outbreak will continue expanding across the United States. We can, therefore, anticipate that a growing number of hospitals will face medical needs that outpace the existing supply of ventilators, protective equipment and other essentials, as well as the rate that enhanced supply can be produced, acquired, and put into place. These circumstances will require a shift to CSC.”
CSC have the joint goals of extending the availability of key resources and minimizing the impact of shortages on clinical care. CSC strive to save the most lives possible, recognizing that some individual patients will die, who would survive under usual care. Implementation of CSC will require facility-specific decisions regarding the allocation of limited resources, including how patients will be triaged to receive life-saving care.
“Decisions made at the bedside should be evidence-based. Current predictive scoring systems of patient outcomes have unclear value in the COVID-19 context. Evidence-based care guidelines may emerge over the course of the pandemic, and with them, CSC guidelines should also evolve, if feasible.”
During a catastrophic crisis, it is vitally important to uphold the core ethical principles of fairness, duty to care, duty to steward resources, transparency in decision making, consistency, proportionality, and accountability. When resource scarcity reaches catastrophic levels, clinicians are ethically justified—and, indeed, are ethically obligated—to use the available resources to sustain life and wellbeing to the greatest extent possible. “Shifting to crisis standards of care is the only ethically tenable approach to shortages of health care resources. Ultimately, this shift represents not a rejection of ethical principles but their embodiment.”
The rapid expert consultation on CSC for COVID-19 can be read here.
If you or a loved one may have a COVID-19 medical malpractice claim in the United States, you should promptly contact a local COVID-19 medical malpractice lawyer in your state who may investigate your COVID-19 malpractice claim for you and represent you and/or your loved one in a COVID-19 medical malpractice case, if appropriate.
Click here to visit our website or call us toll-free in the United States at 800-295-3959 to find COVID-19 claim attorneys in your U.S. state who may assist you.
Turn to us when you don’t know where to turn.