Withholding Medical Care & Ageism During a Pandemic: A Model for Resource Allocation Decision-Making (SCI959)

Abstract

1.Identify the differences between public health ethics and clinical ethics.2.Critically examine new model for resource allocation decision making that minimizes the effects of ageism. Decisions surrounding withholding and withdrawing care are common within the palliative and hospice care community. The unexpected effects of the recent pandemic heavily burdened the healthcare system and ignited conversations about withholding care among providers with limited expertise in palliative care. Discussions surrounding scarcity of resources and withholding care based on age were taking place. The purpose of this literature review was to examine these factors in order to develop a new model for resource allocation decision making that minimizes the effects of ageism. Medical databases were searched using keywords including: end of life/palliative care, resource allocation, withholding/withdrawing care, pandemic, public health, and ethics. Articles published between 2010-2020 on resource allocation decision making were included. Review articles or those that did not meet minimum quality score were excluded. Twenty-three articles were included in the analysis. Study purpose, sample, design and Results were extracted from each article. Using the matrix method, commonalities were further analyzed both within and across the sample. Public health ethics differs from clinical ethics by giving priority to promoting the greatest good over the protection of individual autonomy. This divide in ethics shed light on the dangers associated with ageism. Ageism is the discrimination of individuals based on their age. Age is often a component within clinical instruments that guide clinicians with resource allocation decision making. Basing decisions solely on age without evaluating health and functional status is dangerous and further propagates the discriminatory practices that fuel ageism. Previous research identified using the ethical principles to guide resource allocation decisions but that may not be enough to protect the rights of older adults. Functionality, years of life versus number of lives saved, eliciting patient goals of care and fostering trustworthiness in the public are all important factors involved with resource allocation decisions, including withholding medical care.