Dr Elizabeth Fenton1
1University Of Otago, , Aotearoa / New Zealand
Biography:
Elizabeth is a senior lecturer in the Bioethics Centre at the University of Otago with a background in philosophy and public health. She was previously a fellow in the Program in Ethics and Health at Harvard University, and a senior policy and research analyst at the U.S. Presidential Bioethics Commission under the Obama administration. Her research focuses on ethical issues in public health, global health, and health policy.
Abstract:
Aim:
The aim of this research was to examine the ethical and clinical acceptability of a reserve bed system (RBS) to advance health equity in the allocation of limited intensive care unit (ICU) resources during a public health emergency in Aotearoa New Zealand.
Methods:
We interviewed 7 participants who work in a capacity closely related to ICU operations or policy, including clinicians, nurses, and policy makers. Participants read a brief outline of the RBS proposal and two scenarios before the interview. Each scenario described the RBS proposal with respect to a different priority group (health care workers and patients of Māori ethnicity). The data was analysed using thematic analysis.
Results:
Support was low for the RBS as a method to advance equity in the ICU overall. Some participants saw the potential for the RBS to advance health equity for Māori although this was limited by tensions that complicate its implementation. These tensions arose for both scenarios and ranged across 4 themes: 1) institutional constraints; 2) practical realities; 3) social acceptability; and 4) professional values.
Conclusion:
Advancing health equity is an important consideration and professional value for those working in the ICU context in Aotearoa New Zealand. However, implementing measures to achieve more equitable health outcomes in the ICU is ethically, socially, and politically challenging. As a potential measure for advancing equity the RBS raises more problems for ICU-affiliated staff than its solves. Alternative innovative ways of allocating ICU resources, such as reverse triage, should continue to be considered.