1. Fair Allocation of Scarce Medical Resources in the Time of Covid-19
2. Emanuelet al. “Fair Allocation ” 2052 (emphasis added).
3. See for example Hospital & Healthsystem Association of Pennsylvania Interim Pennsylvania Crisis Standards of Care for Pandemic Guidelines version 2 (Pennsylvania Department of Health April 10 2020) https://www.health.pa.gov/topics/Documents/Diseases%20and%20Conditions/COVID-19%20Interim%20Crisis%20Standards%20of%20Care.pdf pp. 30‐33; Subject Matter Experts Advisory Panel for the Governor's Expert Emergency Epidemic Response Committee Crisis Standards of Care Guidelines for Hospitals for the COVID‐19 Pandemic version 2.0 (Colorado Department of Public Health & Environment April 26 2020) 34 athttps://www.colorado.gov/pacific/cdphe/colorado-crisis-standards-care; Executive Office of Health and Human Services Crisis Standards of Care Planning Guidance for the COVID‐19 Pandemic(Commonwealth of Massachusetts Department of Public Health April 7 2020) 16‐17 21 at COVID‐19 Public Health Guidance and Directives https://www.mass.gov/info-details/covid-19-public-health-guidance-and-directives; Oklahoma State Department of Health “Hospital Crisis Standards of Care: Resource Reference Cards ” April 7 2020 https://www.ok.gov/health2/documents/Hospital%20Crisis%20Standards%20of%20Care.pdf p. 28; Missouri Hospital Association A Framework for Managing the 2020 COVID‐19 Pandemic Response and Implementing Crisis Standards of Care version 1.0 (April 6 2020) https://medicine.missouri.edu/sites/default/files/A_Framework_for_Managing_2020_COVID.pdf p. 18; State of New Jersey Department of Health “Allocation of Critical Care Resources during a Public Health Emergency ” April 11 2020 https://nj.gov/health/legal/covid19/FinalAllocationPolicy4.11.20v2%20.pdf pp. 8‐9. This final source from New Jersey notes that it is “[a]dapted from the University of Pittsburgh Model Policy”; the March 26 2020 version of this policy “Allocation of Scarce Critical Care Resources during a Public Health Emergency ” from the Department of Critical Care Medicine at the University of Pittsburgh School of Medicine is available as the second document in an appendix here: jvp200068supp1_prod.pdf. We have conducted a comprehensive review of state protocols and emergency response plans and have carefully differentiated the plans based on their use of life‐years fair innings and other age‐based criteria for resource allocation. E. Scire et al. “Rationing with Respect to Age during a Pandemic: A Comparative Analysis of State Pandemic Preparedness Plans” (unpublished manuscript 2020) Microsoft Word file.
4. None of the expert reports cited by Emanuel et al. explicitly prioritize the value of saving more years of life over other relevant values. One report does not mention life‐years at all; another discusses life‐years life cycles and fair innings (among other related concepts or values) and ultimately adopts a multiple‐principle approach. In fact one of the expert reports cited Ventilator Allocation Guidelines by the New York State Task Force on Life and the Law states “Proponents of excluding elderly adults believe that children should be offered ventilator therapy over individuals who have lived long lives arguing that it is more appropriate to maximize the life‐years saved rather than the number of lives saved. However the Task Force believed that to exclude older adults discriminates against the elderly especially where there is a greater likelihood that the advanced‐aged patient will survive” (p. 45) (published November 2015 by the New York State Department of Health the report is available athttps://www.health.ny.gov/regulations/task_force/reports_publications/docs/ventilator_guidelines.pdf).
5. Decline in Tuberculosis: The Death Rate Fails to Tell the Entire Story;Dempsey M.;American Review of Tuberculosis,1947