Fair decisions more important when hospitals face crisis like SARS

But international medical ethics specialists (appendix 1) who evaluated the performance of one large Toronto area hospital during last year's SARS outbreak conclude that procedural requirements, particularly fair and ethical priority-setting, are even more important in the midst of a crisis.

"Hospitals operate at their best when staff and patients trust the process," says Doug Martin, PhD, who led the study for the University of Toronto Joint Centre for Bioethics (JCB). "But the SARS outbreak raised questions that many hospital administrators and staff had never faced before."

The study group identified a number of decision-making difficulties affecting both SARS and non-SARS patients.

Among them:

  • To what extent should the need to contain the outbreak override other important needs? In early stages of the outbreak, the hospital suspended all surgery and banned visitations, causing considerable hardship to the most seriously ill non-SARS patients and their families; and

  • To what extent should the need for quick decisions override the need for legitimate and fair decision making? Upon resumption of normal hospital operations, there was considerable pressure to move quickly to ease the surgical backlog.

    The group's report, published today by U.K.-based Biomed Central, concludes that "in the midst of a crisis such as SARS where guidance is incomplete, consequences uncertain and information constantly changing, where hour-by-hour decisions involve life and death, fairness is more important rather than less."

    The hospital's decision making practices were evaluated using the "accountability for reasonableness" ethical framework, developed by the JCB to guide fair priority setting in health care organizations. Under this framework, an institution's priority setting is judged fair if four conditions are met:

  • Relevance: Rationales for priority setting decisions must rest on rea

  • Contact: Terry Collins
    University of Toronto Joint Center for Bioethics

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