Public consultation: Ethical Framework for Resource Allocation During Times of Scarcity

NEAC have developed a draft Ethical Framework for Resource Allocation During Times of Scarcity.

NEAC’s Framework is a high-level guidance document for the health and disability sector that would help health workers and policy makers consider ethics when deciding how to allocate resources. It sets out four essential ethical principles, and four Te Tiriti principles, that medical staff, service planners and policy analysts should consider when responding to a pandemic.

The Framework adds an equity lens to decision making and assesses how equity sits alongside other ethical principles and Te Tiriti. Equity as a concept recognises different people have different levels of advantage and so require different approaches and resources to get equitable health outcomes.

In a resource allocation setting, this means that health workers and policy makers should consider how resources can be allocated to mitigate the adverse consequences of pandemic response measures while at the same time avoiding or minimising growth in inequity from those measures.

Consulting on the draft Ethical Framework

NEAC called for public submissions on the Framework on 16 June 2020. The consultation ran for four weeks; it closed on 15 July 2020. However, NEAC accepted late submissions; the final submission was received on 29 July 2020.

NEAC sought feedback on the following.

1. Whether the Framework captures the ethical tensions in resource allocation in times of scarcity.
2. Whether the Framework helps decision-makers understand the ethical implications of making decisions.
3. Whether the Framework helps decision-makers consider equity when responding to COVID-19.
4. Feedback on the Te Tiriti Principles and their application to resource allocation decisions.
5. Any further comments and suggested changes for NEAC to consider for the final draft.
6. What ethical issues or areas of work you think should be covered in a substantial review of Getting Through Together.

Summary of submissions

NEAC produced a summary of submissions following the consultation on the draft standards.

• Summary of Submissions: Consultation on the Draft Ethical Framework for Resource Allocation in Times of Scarcity [DOCX, 382 KB]
• Summary of Submissions: Consultation on the Draft Ethical Framework for Resource Allocation in Times of Scarcity [PDF, 344 KB]
• Resource allocation feedback: CCDHB & HVDHB ICU triage pandemic working group [PDF, 101 KB]
• Resource allocation feedback: Redacted submissions [PDF, 1.9 MB]
• Asian stakeholder feedback: Waitemata DHB [PDF, 83 KB]

Final document

You can find the final document at Ethics and Equity: Resource Allocation and COVID-19.

Background

NEAC recognise that this Framework for Resource Allocation only addresses a small part of pandemic ethics, and is currently focused on COVID-19.

NEAC is the author of the 2007 document Getting Through Together: Ethical Values for a Pandemic. Getting Through Together considers the ethical issues which may arise during any pandemic. NEAC are commencing a substantial review of Getting Through Together, which will build on the work in developing this Framework.

NEAC believe that Getting Through Together needs to be updated for two reasons.

The first is to consider ethical issues not covered by the 2007 document, including use of digital technologies, specific guidance on public health interventions and the impact on routine standards of care, and consideration of equity.

The second relates to the structure of the document. The current document is difficult to use when considering the real COVID-19 pandemic. The target audience of a pandemic ethics document are decision-makers, government and the public. Accordingly, the document should be clear and easy to navigate.

The consultation asks for your views on ethical issues on pandemic ethics more generally, to inform NEACs future work on pandemic ethics.