Law and Medicine scholar Haavi Morreim recently posted an excellent analysis of the problem on a discussion list maintained by the American Health Law Association. I reproduce it here, with Haavi's permission:Issues of triage and rationing in Covid-19 have been discussed extensively within the bioethics community. One prominent protocol (adapted and/or adopted at many sites) aims to maximize lives saved, and also life-years saved; additionally it emphasizes transparency with both the community and the patient/family. The authors of these protocols have strived mightily to achieve something intellectually satisfying, ethically excellent.
A major flaw has been that, to maximize life-years saved, we look to co-morbidities. So guess which communities have the highest rates of co-morbidity - - yes, it's minority communities. Add to this the fact that the SOFA score these protocols use is well-acknowledged not to be highly accurate in predicting mortality ("yes we know, but it's the best we have").
And now add in the huge mistrust that many minority communities have for the healthcare establishment. At the front end, that mistrust has many in these communities reluctant to be tested at all (fear that "you're putting the virus on that swab so you can give me the disease" has been documented) - - and indeed, sometimes reluctant to seek regular care (my pediatrics colleagues find some of their minority mothers reluctant to accept routine vaccinations for their children, citing fear that the vaccines now have the virus inserted into them).
And now add in transparency + that mistrust. We're supposed to tell a minority family "your dad won't be intubated because he doesn't meet our criteria." "Our criteria . . . " So we (the ones they mistrust) will supposedly assure them "our criteria" are racially neutral. But in fact they are not. Check out NEJM, online June 18: Vyas et al, "Hidden in Plain Sight - Reconsidering the Use of Race Correction in Clinical Algorithms" (attached). It has long been documented that racial minorities receive less care, on many fronts. This piece explains part of the reason why. Minority distrust of the healthcare system is not some sort of mindless, baseless paranoia.
My prediction -- and what has actually happened, so far, across the country -- is that healthcare providers will not actually implement these protocols. They will find another vent, split a vent 2 or 4 ways, retrain another nurse . . . do whatever it takes to avoid this sort of rationing. And they will be right to do that.
