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American Journal of Bioethics.

Eliminating Categorical Exclusion Criteria in Crisis Standards of Care Frameworks

During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift—to some degree—from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by “crisis standards of care,” but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities.

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Volume 20, Issue 7
July 2020

Target Articles.

Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force Amy L. McGuire, Mark P. Aulisio, F. Daniel Davis, Cheryl Erwin, Thomas D. Harter, Reshma Jagsi, Robert Klitzman, Robert Macauley, Eric Racine, Susan M. Wolf, Matthew Wynia, Paul Root Wolpe & The COVID-19 Task Force of the Association of Bioethics Program Directors (ABPD)
Eliminating Categorical Exclusion Criteria in Crisis Standards of Care Frameworks Catherine L. Auriemma, Ashli M. Molinero, Amy J. Houtrow, Govind Persad, Douglas B. White & Scott D. Halpern
Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis? Marlyse F. Haward, Annie Janvier, Gregory P. Moore, Naomi Laventhal, Jessica T. Fry & John Lantos
COVID in NYC: What We Could Do Better Tia Powell & Elizabeth Chuang
Ethics Lessons From Seattle’s Early Experience With COVID-19 Denise M. Dudzinski, Benjamin Y. Hoisington & Crystal E. Brown