At the beginning of the COVID-19 pandemic, health care agencies and those helping to guide their decision-making spent significant time and energy developing mechanisms and the associated moral justification to allocate scarce medical resources. Driven by some reported shortages, some agencies considered whether standard allocation schema could be applied to the distribution of scarce opioids.
The problem, we argue, is that the standard allocation schema do not work for opioids because of important practical and philosophical differences between treating pain and treating, for example, respiratory distress. These differences mean some standard allocation schema are irrelevant (e.g., one’s status as a health care worker) or only apply in a limited way (e.g., prognosis).
We argue that the morally optimal allocation scheme is a tiered lottery in which priority is primarily determined by self-reported pain score. The first tier consists of patients who need opioids for controlling the most severe pain that results from necessary and emergent live-saving procedures. The next four tiers consist of patients with different degrees of severe pain (scores of 10, 9, 8, and 7, respectively), such that those in the most pain are in the second tier, and those in slightly lesser, but still severe, pain are in subsequent tiers. Each tier has its own lottery. Additionally, we argue that some deception, in the form of withholding information from patients about the implementation and details of a pain lottery, is ethically permissible to address unique challenges that arise for the treatment of pain in conditions of scarcity.
Casey Chmura – None – Western Michigan University Homer Stryker M.D. School of Medicine; Abram Brummett, PhD, HEC-C – Foundational Sciences – Oakland University William Beaumont School of Medicine
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