A Model Hospital Policy for Fair Allocation of Medications to Treat COVID-19

Available now online:

To assist hospitals and health systems to implement a transparent and fair approach to allocate scarce medications to treat patients with COVID-19, we have created a model hospital policy and allocation framework. Hospitals and health systems are welcome to adapt the policy for their specific needs. Click here to download a PDF version of the Model Hospital Policy for Fair Allocation of Medications to Treat COVID-19.

Since March 2020, the number of clinical trials to assess the efficacy of medications to treat COVID-19 has expanded rapidly. As the trials start to identify beneficial therapies, hospitals will face difficult choices about which patients should be treated when there is not enough medication to treat all patients with COVID-19.

Dr. Douglas White led a multidisciplinary team to develop a framework to fairly allocate scarce COVID-19 treatments. The team included diversity and inclusion experts, ethicists, economists, and medical specialists from the University of Pittsburgh, Harvard University, University of Denver, Boston College and MIT.

What are the important features of the model policy?

  1. An allocation team, not the treating clinicians, makes the allocation decisions. This promotes objectivity, avoids conflicts of commitment, and minimizes clinicians’ moral distress.
  2. The framework is designed to enhance medical benefit for communities, ensure meaningful access and individualized assessments for all patients, avoid discrimination, and mitigate disparities in outcomes due to social inequalities.
  3. The model policy uses a weighted lottery or categorical reserve system to fairly allocate drug supplies if there is insufficient supply to treat all eligible patients.

About Dr. Douglas White, MD, MAS

Dr. White is the UPMC Endowed Chair for Ethics in Critical Care Medicine and professor of Critical Care Medicine, Medicine, and Clinical and Translational Science in the Department of Critical Care Medicine at the University of Pittsburgh. Professor White is director of the CRISMA Program on Ethics and Decision Making in Critical Illness. He and his colleagues conduct scholarly work to understand and improve how medical decision are made for critically ill patients, many of whom are unable to made decisions for themselves. Dr. White is available for consultation on the policy by sending an email to douglas.white [at] pitt.edu.

References

White DB, Lo B. A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic. JAMA. 2020 Mar 27.

DeJong C, Chen AH, Lo B. An Ethical Framework for Allocating Scarce Inpatient Medications for COVID-19 in the US. JAMA. 2020 May 15.

Pathak PA, Sönmez T, Unver MU, Yenmez MB. Leaving No Ethical Value Behind: Triage Protocol Design for Pandemic Rationing.

Daugherty Biddison EL, Gwon H, Schoch-Spana M, Cavalier R, White DB, Dawson T, Terry PB, London AJ, Regenberg A, Faden R, Toner ES. The community speaks: understanding ethical values in allocation of scarce lifesaving resources during disasters. Annals of the American Thoracic Society 2014;11:777-83.

Daugherty Biddison EL, Gwon HS, Schoch-Spana M, Regenberg AC, Juliano C, Faden RR, Toner ES. Scarce Resource Allocation During Disasters: A Mixed-Method Community Engagement Study. Chest 2018;153:187-95.