What is the public's view of tiebreakers in the prioritization protocols for accessing critical care in extreme pandemic context COVID-19?

Background: Prioritization protocols for accessing adult critical care in the extreme context of a pandemic contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. These criteria have been controversial, and little is known about public acceptability in this pandemic.

Objective: To explore the perspectives of the public from Quebec and Ontario on tiebreakers, identifying the most acceptable ones, and their underlying values.

Methods: This was a qualitative study of two online democratic deliberations held in June 2022. Participants were recruited from Quebec and Ontario, excluding healthcare professionals. They were first informed about their protocols, and subsequently deliberated on the acceptability of tiebreakers. Deliberations were subject to thematic content analysis.

Results: A total of 47 citizens from Quebec (n=20) and Ontario (n=27) took part in the deliberations. Emerging themes were: Priority to young patients – Life cycle – a preferred tiebreaker; Randomization – a tiebreaker of last resort; Multiplier effect of most exposed healthcare workers – a tiebreaker of moderate acceptability; and Social value – a tiebreaker of low acceptability. The main argument for the life cycle was based on equity. Solidarity towards new generations was also stated. Social value of individuals was considered unfair.

Conclusion: Life cycle was the preferred tiebreaker for participants because this criterion respects the intergenerational equity, which was relevant to them in allocating scarce resources to adult patients during an extreme pandemic. The focus on younger patients is consistent with other public consultations conducted around the world.

Marie-Eve Bouthillier, PhD – Clinical Assistant Profesor, Family and Emergency Medicine, Université de Montréal; Yanick Farmer, PhD – Full professor, Social and Public Communication, Université de Québec à Montréal