There are tools to address the racial/ethnic health disparities exposed by the coronavirus

There are tools to address the racial/ethnic health disparities exposed by the coronavirus

Now that we can quantify it, leaders have a moral obligation to address the problem

By: Victor Villagra, MD and Emil Coman, PhD, CT Mirror, May 22, 2020. Available Here.  

In early April, Connecticut Gov. Ned Lamont announced that COVID-19 infections and deaths are far more frequent among African-Americans than in any other racial/ethnic group. The Connecticut Department of Public Health has since been documenting this disparity on a real-time basis.

This reporting is commendable and is compatible with Connecticut’s public commitment to eliminate long-standing healthcare disparities. Before the pandemic the public was already well aware that racial and ethnic disparities exist, but advocates are increasingly frustratedthat a more aggressive, real-time solution for this chronic injustice is still not an explicit and prominent part of the state response to the crisis.

In his recent press-conference on May 20, the governor mentioned that the response is focusing on high risk populations, correctly naming prisons and nursing homes but there was no mention of racial/ethnic minorities even as DPH reports regularly how they are bearing a disproportionate burden of illness and death.

Connecticut, one of the wealthiest states in the country, is confronting an unprecedented scarcity of healthcare resources. Shortages of PPEs, insufficient access to testing, and limited support for those with little or no financial reserves to survive the lockdown raise practical and ethical questions about how scarce resources are allocated. One of the most emotionally charged decisions receiving media attention has been who has priority when allocating scarce life-saving ventilators. What criteria should guide that decision?

There is wide consensus within the ethics community that the allocation of scarce resources during a crisis should include two well-vetted principles: the equal moral worth of all individuals and the effort to save the greatest number of lives. But how are these principles applied to the allocation of ventilators during the COVID-19 pandemic?

The philosophical tenet of equal moral worth has intuitive merit, but it is difficult to find its practical applicability when deciding who gets a ventilator and who does not.  In intensive care units (ICUs), medical and physiologic parameters measured repeatedly at the bedside can predict who is more likely to survive and who is not.

A “survivability” score may be the deciding factor, maybe something else, but whatever criterion is used, the decision must somehow be tethered to the equal moral worth principle which inevitably raises questions of fairness. The justification for any priority system must be as explicit as possible and transparent in order to harness the public’s trust.

A number of alternative criteria have been thoroughly studied with input from diverse groups of citizens, ethicists and critical care professionals. Alternatives have included a lottery, first-come, first-served; those with the most years left to live (e.g.: younger vs older or healthy vs people with terminal illness) and those with the most value to others in the pandemic (e.g.: healthcare workers).

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