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CME / ABIM MOC

Pandemic Treatment Resource Allocation Ethics and Nondiscrimination

  • Authors: Case History and Commentary by Jeffrey T. Berger, MD; Lois Snyder Sulmasy, JD; and Matthew DeCamp, MD, PhD
  • CME / ABIM MOC Released: 8/20/2020; Reviewed and Renewed: 8/18/2021
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 8/18/2022
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Target Audience and Goal Statement

This article is intended for internists, infectious disease physicians, intensivists, emergency physicians, pulmonologists, and other physicians caring for patients in the context of a pandemic such as coronavirus disease 2019 (COVID-19) as well as hospital administrators.

The goal of this activity is to describe ethical considerations involved in planning for resource prioritization during a pandemic, according to an American College of Physicians (ACP) case study and commentary.

Upon completion of this activity, participants will be able to:

  • Describe ethical considerations involved in triage during a pandemic, according to an ACP case study and commentary
  • Determine ethical considerations involved in institutional support and physicians' duty to care during a pandemic, according to an ACP case study and commentary
  • Identify ethical considerations regarding medicine's additional responsibilities to society during and after a pandemic, according to an ACP case study and commentary


Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Authors, Case History and Commentary

  • Jeffrey T. Berger, MD

    Professor of Medicine
    New York University (NYU) Long Island School of Medicine
    Chief
    Division of Palliative Medicine and Bioethics
    NYU Winthrop Hospital
    Mineola, New York

    Disclosures

    Disclosure: Jeffrey T. Berger, MD, has disclosed no relevant financial relationships.

  • Lois Snyder Sulmasy, JD

    Director
    Center for Ethics and Professionalism
    American College of Physicians
    Philadelphia, Pennsylvania

    Disclosures

    Disclosure: Lois Snyder Sulmasy, JD, has disclosed no relevant financial relationships.

  • Matthew DeCamp, MD, PhD

    Associate Professor
    Department of Medicine
    University of Colorado - Anschutz Medical Campus
    Aurora, Colorado

    Disclosures

    Disclosure: Matthew DeCamp, MD, PhD, has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Editor

  • Lois Snyder Sulmasy, JD

    Director
    Center for Ethics and Professionalism
    American College of Physicians
    Philadelphia, Pennsylvania

    Disclosures

    Disclosure: Lois Snyder Sulmasy, JD, has disclosed no relevant financial relationships.

CME Reviewer

  • Hazel Dennison, DNP, RN, FNP, CHCP, CPHQ, CNE

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Hazel Dennison, DNP, RN, FNP, CHCP, CPHQ, CNE, has disclosed no relevant financial relationships.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

The authors would like to thank Paula Katz, staff at the ACP Center for Ethics and Professionalism, for editorial assistance.


Accreditation Statements



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    For Physicians

  • The case history and commentary were developed by the American College of Physicians.

    Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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CME / ABIM MOC

Pandemic Treatment Resource Allocation Ethics and Nondiscrimination

Authors: Case History and Commentary by Jeffrey T. Berger, MD; Lois Snyder Sulmasy, JD; and Matthew DeCamp, MD, PhDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME / ABIM MOC Released: 8/20/2020; Reviewed and Renewed: 8/18/2021

Valid for credit through: 8/18/2022

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CASE HISTORY

A pandemic respiratory virus has gripped the United States, including the area served by Community Healthcare Trust Incorporated (Community), a large, integrated health system that includes several area hospitals, multiple specialty and subspecialty groups, and primary care clinics. The best models and estimates regarding the pandemic are dire. Although uncertain, they suggest that infections will peak in 18 days and that, if so, patient need for critical resources, such as ventilators, could exceed the current total capacity. As a result, Community has to plan for the worst while hoping to increase capacity and that state and local public health measures and "shelter in place" orders can stem the tide of infections.

Community has decided to create a team to develop institutional policy on how to allocate scarce resources in the event the pandemic is as bad as models predict. Dr Giles, an internal medicine physician and ethicist for Community, has been asked to join this team and lead the drafting of the policy.

Dr Giles just got off the phone with Dr Stead, a critical care colleague and friend in a smaller community in another state. Dr Stead was distressed, relaying that staffing is strapped, as a number of employees are home ill, on quarantine, caring for ill relatives, or engaged in childcare because of school closures intended to prevent spread of disease. Almost every intensive care unit bed is occupied by a patient receiving mechanical ventilation, and new patients are arriving regularly at the emergency department (ED) in respiratory distress. Dr Stead noted that among the patients currently in his ICU whose condition is most dire is the grandmother of the hospital's director of social work. A half dozen of her friends and family members were in the lobby wanting to go to her bedside; meanwhile, he just evaluated an elderly leader in his church and a 24-year-old patient with asthma and severe viral pneumonia for possible admission from the ED. The elderly man's brother (a health professional) keeps mentioning the Emergency Medical Treatment & Labor Act (EMTALA).

Dr Giles can only imagine what his hospital soon may be facing. What ethical considerations and principles should guide Dr Giles in drafting the policy?

Table of Contents

  1. CASE HISTORY
  2. COMMENTARY
  • Print