CHEST Guidelines-Age,-“Life-Cycles,”-and-the-Allocati

Age,-“Life-Cycles,”-and-the-Allocati

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The document discusses the ethical complexities of using age as a criterion for allocating scarce medical resources, such as ventilators, during crises like the COVID-19 pandemic. It highlights the situation in Italy, where both elderly patients and younger patients with significant comorbidities were denied ventilators due to a shortage, indicating that the primary criterion was the likelihood of survival rather than age per se.<br /><br />It critiques the "life-cycle" approach suggested by Douglas White and Bernard Lo, which supplements the idea of "saving the most lives" with considerations of "life years," suggesting that individuals should have equal opportunities to progress through different life stages. This approach acts as a tie-breaker in resource allocation when patients have similar prognoses. However, the authors argue that scenarios requiring a choice between significantly different life expectancies, such as a 15-year-old versus a 55-year-old, are unlikely in practice. They point out that the younger demographic is far less likely to require intensive care or ventilators, reducing the practicality of such scenarios.<br /><br />The paper argues that real-life situations are more likely to involve distinctions between closer age brackets with similar risks and comorbidities, like a 58-year-old and a 63-year-old. It suggests that life-cycle considerations complicate the decision-making process, as they require value judgments that may not align with societal values or ethical norms. The authors advocate for focusing more on short-term medical prognoses and benefit likelihood rather than subjective assessments of life-cycle worth.<br /><br />Ultimately, they support the Swiss guidelines that do not use age as an explicit allocation criterion, but recognize age-related comorbidities affecting short-term prognoses. This framework maintains fairness by focusing on medical expertise and the likelihood of benefit, without assessing who is more deserving based on life stages experienced.

Keywords

ethical complexities

medical resource allocation

ventilator shortage

COVID-19 pandemic

life-cycle approach

survival likelihood

age-related comorbidities

Swiss guidelines

medical prognoses

resource allocation fairness