Paeds Cases · professional-practice-and-evidence
Ethical allocation of resources in paediatrics — OSCE
OSCE station: explaining a fair-allocation decision to the family of a child who did not receive a scarce PICU bed during a surge, applying the triage principles, the comfort-care guarantee and the appeal pathway.
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Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
During a winter surge the last PICU bed is allocated by triage protocol to a child with a better short-term prognosis; the candidate must meet the family of the child who did not receive the bed and explain the decision.
Objectives
- Explain a triage allocation decision to a family using transparent, principle-based language. [1]
- Reassure the family that the decision reflects scarcity, not a judgement that their child's life is worth less. [8]
- Guarantee that allocation withdraws only the specific intervention and that comfort care continues. [8]
- Offer the appeal pathway and name the ethics committee. [2] [6]
References4ShowHide
- [1]Persad G, Wertheimer A, Emanuel EJ Principles for allocation of scarce medical interventions. Lancet, 2009.PMID 19186274
- [2]Daniels N, Sabin J Limits to health care: fair procedures, democratic deliberation, and the legitimacy problem for insurers. Philos Public Aff, 1997.PMID 11660435
- [6]Christian MD, Hawryluck L, Wax RS, et al Development of a triage protocol for critical care in an influenza pandemic. CMAJ, 2006.PMID 17116904
- [8]Antommaria AH, Powell T, Miller JE, et al Ethical issues in pediatric emergency mass critical care. Pediatr Crit Care Med, 2011.PMID 22067926