TY - JOUR
T1 - Identifying ethical values for guiding triage decisions during the COVID-19 pandemic
T2 - An Italian ethical committee perspective using Delphi methodology
AU - Zeneli, Anita
AU - Brandi, Giovanni
AU - Di Pasquale, Giuseppe
AU - Orlandini, Danilo
AU - De Carolis, Piero
AU - Bravi, Francesca
AU - Pugliese, Francesco
AU - Poluzzi, Elisabetta
AU - Catena, Fausto
AU - Giovanardi, Filippo
AU - Valpiani, Giorgia
AU - Mantovani, Renato
AU - Magnanimi, Eugenia
AU - Iannone, Primiano
N1 - Publisher Copyright:
© 2021 BioMed Central Ltd.. All rights reserved.
PY - 2021/5/18
Y1 - 2021/5/18
N2 - Objectives This study aimed to identify the guiding ethical principles that should be considered for critical resource allocation during pandemic emergency situations, and especially for the COVID-19 outbreak. The secondary objective was to define the priority to be assigned to each principle. Setting The study was conducted from March to June 2020 within the context of an ethical committee (EC) in Northern Italy. Participants Eleven EC members and five additional external healthcare and bioethical professionals, forming a multidisciplinary panel, took part in the study. Primary and secondary outcome measures The compilation of a list of ethical principles (maximum of 10 items) and their priority ranking and application within an emergency pandemic context was established as the expected outcome of this work. Results A consensus on 10 guiding ethical principles was reached by the multidisciplinary panel. Transparency ranked first on the priority list as the most frequently voted principle, followed by the number of lives saved, life-years saved, respect for individuals' autonomy and equity. Other principles including life cycle, € sickest first', reciprocity, instrumental value and lottery were also considered appropriate as potential tiebreakers. These principles were discussed and made consistent with the current Italian pandemic context by producing an explanatory document. Conclusions The identified principles could be used in preparedness plans to guide resource allocation during pandemic events. By combining their rank and relevance in relation to disease, health system organisations, social and economic settings, and critical resources at risk of scarcity, these principles could help to maximise the benefit of resource use for the community, thus reducing inequalities for individuals.
AB - Objectives This study aimed to identify the guiding ethical principles that should be considered for critical resource allocation during pandemic emergency situations, and especially for the COVID-19 outbreak. The secondary objective was to define the priority to be assigned to each principle. Setting The study was conducted from March to June 2020 within the context of an ethical committee (EC) in Northern Italy. Participants Eleven EC members and five additional external healthcare and bioethical professionals, forming a multidisciplinary panel, took part in the study. Primary and secondary outcome measures The compilation of a list of ethical principles (maximum of 10 items) and their priority ranking and application within an emergency pandemic context was established as the expected outcome of this work. Results A consensus on 10 guiding ethical principles was reached by the multidisciplinary panel. Transparency ranked first on the priority list as the most frequently voted principle, followed by the number of lives saved, life-years saved, respect for individuals' autonomy and equity. Other principles including life cycle, € sickest first', reciprocity, instrumental value and lottery were also considered appropriate as potential tiebreakers. These principles were discussed and made consistent with the current Italian pandemic context by producing an explanatory document. Conclusions The identified principles could be used in preparedness plans to guide resource allocation during pandemic events. By combining their rank and relevance in relation to disease, health system organisations, social and economic settings, and critical resources at risk of scarcity, these principles could help to maximise the benefit of resource use for the community, thus reducing inequalities for individuals.
KW - COVID-19
KW - ethics (see medical ethics)
KW - intensive & critical care
KW - medical ethics
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U2 - 10.1136/bmjopen-2020-043239
DO - 10.1136/bmjopen-2020-043239
M3 - Review article
C2 - 34006543
AN - SCOPUS:85106165213
VL - 11
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 5
M1 - e043239
ER -