TY - JOUR
T1 - The community speaks
T2 - Understanding ethical values in allocation of scarce lifesaving resources during disasters
AU - Biddison, Elizabeth L.Daugherty
AU - Gwon, Howard
AU - Schoch-Spana, Monica
AU - Cavalier, Robert
AU - White, Douglas B.
AU - Dawson, Timothy
AU - Terry, Peter B.
AU - London, Alex John
AU - Regenberg, Alan
AU - Faden, Ruth
AU - Toner, Eric S.
PY - 2014/6
Y1 - 2014/6
N2 - Introduction: Pandemic influenza or other crises causing mass respiratory failure could easily overwhelm current North American critical care capacity. This threat has generated large-scale federal, state, and local efforts to prepare for a public health disaster. Few, however, have systematically engaged the public regarding which values are most important in guiding decisions about how to allocate scarce healthcare resources during such crises. Methods: The aims of this pilot study were (1) to test whether deliberative democratic methods could be used to promote engaged discussion about complex, ethically challenging healthcare-related policy issues and (2) to develop specific deliberative democratic procedures that could ultimately be used in a statewide process to inform a Maryland framework for allocating scarce healthcare resources during disasters. Using collaboratively developed focus group materials and multiple metrics for assessing outcomes, we held 5-hour pilot community meetings with a combined total of 68 community members in two locations in Maryland. The key outcomes used to assess the project were (1) the comprehensibility of the background materials and ethical principles, (2) the salience of the ethical principles, (3) the perceived usefulness of the discussions, (4) the degree to which participants' opinions evolved as a result of the discussions, and (5) the quality of participant engagement. Results: Most participants were thoughtful, reflective, and invested in this pilot policy-informing process. Throughout the pilot process, changes were made to background materials, the verbal introduction, and pre- and post-surveys. Importantly, by holding pilot meetings in two distinct communities (an affluent suburb and inner city neighborhood), we discerned that participants' ethical reflections were framed in large part by their place-based life experiences. Conclusion: This pilot process, coupled with extensive feedback from participants, yielded a refined methodology suitable for wider-scale use and underscored the need for involvement of diverse communities in a statewide engagement process on this critical policy issue.
AB - Introduction: Pandemic influenza or other crises causing mass respiratory failure could easily overwhelm current North American critical care capacity. This threat has generated large-scale federal, state, and local efforts to prepare for a public health disaster. Few, however, have systematically engaged the public regarding which values are most important in guiding decisions about how to allocate scarce healthcare resources during such crises. Methods: The aims of this pilot study were (1) to test whether deliberative democratic methods could be used to promote engaged discussion about complex, ethically challenging healthcare-related policy issues and (2) to develop specific deliberative democratic procedures that could ultimately be used in a statewide process to inform a Maryland framework for allocating scarce healthcare resources during disasters. Using collaboratively developed focus group materials and multiple metrics for assessing outcomes, we held 5-hour pilot community meetings with a combined total of 68 community members in two locations in Maryland. The key outcomes used to assess the project were (1) the comprehensibility of the background materials and ethical principles, (2) the salience of the ethical principles, (3) the perceived usefulness of the discussions, (4) the degree to which participants' opinions evolved as a result of the discussions, and (5) the quality of participant engagement. Results: Most participants were thoughtful, reflective, and invested in this pilot policy-informing process. Throughout the pilot process, changes were made to background materials, the verbal introduction, and pre- and post-surveys. Importantly, by holding pilot meetings in two distinct communities (an affluent suburb and inner city neighborhood), we discerned that participants' ethical reflections were framed in large part by their place-based life experiences. Conclusion: This pilot process, coupled with extensive feedback from participants, yielded a refined methodology suitable for wider-scale use and underscored the need for involvement of diverse communities in a statewide engagement process on this critical policy issue.
KW - Disasters
KW - Ethics
KW - Mechanical
KW - Resource allocation
KW - Ventilators
UR - http://www.scopus.com/inward/record.url?scp=84903640541&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84903640541&partnerID=8YFLogxK
U2 - 10.1513/AnnalsATS.201310-379OC
DO - 10.1513/AnnalsATS.201310-379OC
M3 - Article
C2 - 24762135
AN - SCOPUS:84903640541
SN - 2325-6621
VL - 11
SP - 777
EP - 783
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 5
ER -