A:  The Ethical Guidelines for Allocation of Scarce Medical Resources and Services During Public Health Emergencies in Michigan (Guidelines) provide an ethical framework for the allocation of scarce medical resources and services during public health emergencies.  In the simplest terms, they answer the question of how health care providers can make decisions about access to scarce medical resources when there is not enough for everyone to have access to these resources immediately. 

 

A: The purpose of the Guidelines is to minimize the harm caused by public health emergencies, while allowing fair processes to protect all individuals. Health emergencies, regardless of cause, that affect a significant portion of the population can create critical shortages in drugs, supplies, or even personnel.  With proper planning the effects of these emergencies may be mitigated, but scarcity can still occur despite the best planning efforts.  The Guidelines address how medical care providers handle the rare circumstances in which the number of individuals affected by the health emergency exceeds the resources available to treat them.

 

A: The Guidelines consider a number of ethical principles, including the individual autonomy of health care professionals and patients, the obligation to minimize harm and suffering, the duty to be a careful steward of scarce resources, and the need to provide access to services according to fair processes, among others.

 

A: The Guidelines are designed to provide a consistent framework for coordination and cooperation within the state of Michigan on issues related to scarce resource allocation during emergencies.

 

A: The Guidelines set out three goals: 1) to minimize morbidity and mortality; 2) to maintain the social fabric; and 3) to ensure fairness.

 

A:  The Guidelines have been produced by physicians, nurses, ethicists, lawyers, state officials, and other experts over the past two years.  These individuals have had the opportunity to think critically and discuss the ethical and practical issues involved in scarce resource allocation.  It would be a great burden on health care professionals to expect them to make these difficult ethical decisions without guidance during the stress of a significant public health emergency.  Additionally, the Guidelines ensure that individual decisions do not perpetuate the personal preferences of the decision-maker and lead to unfair or biased results.

 

A:  The specific implementation of these Guidelines will be left to health care providers (hospitals, care facilities, etc…), but there are suggested means of making allocation decisions.  If a public health emergency does occur, members of a statewide advisory panel will be working consistently to advise and update the Guidelines to handle the particularities of each event, and keep health care personnel informed of changes.  In this way the Guidelines can be constantly reevaluated to meet unusual or unforeseen circumstances.

 

A: No. Decisions about care are still made by health care professionals and institutions. The Guidelines recommend criteria to make decisions about allocating scarce medical resources and services during public health emergencies. The ethics-based framework outlined in the Guidelines does not supplant the decision-making authority and responsibility of health care providers. Rather, the Guidelines are a tool that can be applied by health care providers in making decisions and by facilities in development of their own, more specific, protocols for allocating scarce medical resources and services.

 

A:  No.  The Guidelines explicitly prohibit the use of a person’s pre-existing medical condition or long-term medical prognosis as criteria for access to scarce medical resources. 

 

A:  No.  Emergency stockpiles are a critical element of disaster and emergency preparedness.  However, regardless of the stockpiles and anticipatory supplies there is no sure way to eliminate the chance of scarcity.  For example, in a time of a pandemic influenza outbreak, the vaccine to prevent infection may be months in the making, and available only in limited supply.  The Guidelines would allow health care professionals to follow national recommendations and ensure those limited vaccines can be distributed in such a way as to minimize the loss of life and disruption to social order during the outbreak.

 

A:  Because the Guidelines are meant as a means of minimizing the negative effects of health emergencies, first priority will go to those in serious medical condition who have a favorable medical prognosis and also those who are in the best position to help others, such as medical care professionals and others directly involved in responding to the emergency.

 

A:  No.  Wealth, age, sex, ethnicity, national origin, social worth, and other like categories are specifically prohibited as a means of establishing priority under the Guidelines.

 

A:  The Guidelines suggest that these approaches may be used but have shortcomings. A lottery system can be administered with complete fairness, but is not conducive to minimizing the health impact of an emergency. First come, first served is easy to implement, but is not a fair system. People with more resources or greater access to information or transportation are more likely to benefit under this approach than people who are poorer or less savvy with the health care system.

 

A: Health care institutions, such as hospitals, are encouraged to create a process for patients to appeal resource allocation decisions. Each institution will determine internally how such a process will work.