Which factors should be included in triage? An online survey of the attitudes of the UK general public to pandemic triage dilemmas.

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2020-12-08

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Abstract

Objective

As cases of COVID-19 infections surge, concerns have renewed about intensive care units (ICUs) being overwhelmed and the need for specific triage protocols over winter. This study aimed to help inform triage guidance by exploring the views of lay people about factors to include in triage decisions.

Design, setting and participants

Online survey between 29th of May and 22nd of June 2020 based on hypothetical triage dilemmas. Participants recruited from existing market research panels, representative of the UK general population. Scenarios were presented in which a single ventilator is available, and two patients require ICU admission and ventilation. Patients differed in one of: chance of survival, life expectancy, age, expected length of treatment, disability and degree of frailty. Respondents were given the option of choosing one patient to treat or tossing a coin to decide.

Results

Seven hundred and sixty-three participated. A majority of respondents prioritised patients who would have a higher chance of survival (72%-93%), longer life expectancy (78%-83%), required shorter duration of treatment (88%-94%), were younger (71%-79%) or had a lesser degree of frailty (60%-69%, all p<0.001). Where there was a small difference between two patients, a larger proportion elected to toss a coin to decide which patient to treat. A majority (58%-86%) were prepared to withdraw treatment from a patient in intensive care who had a lower chance of survival than another patient currently presenting with COVID-19. Respondents also indicated a willingness to give higher priority to healthcare workers and to patients with young children.

Conclusion

Members of the UK general public potentially support a broadly utilitarian approach to ICU triage in the face of overwhelming need. Survey respondents endorsed the relevance of patient factors currently included in triage guidance, but also factors not currently included. They supported the permissibility of reallocating treatment in a pandemic.

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Published Version (Please cite this version)

10.1136/bmjopen-2020-045593

Publication Info

Wilkinson, Dominic, Hazem Zohny, Andreas Kappes, Walter Sinnott-Armstrong and Julian Savulescu (2020). Which factors should be included in triage? An online survey of the attitudes of the UK general public to pandemic triage dilemmas. BMJ open, 10(12). p. e045593. 10.1136/bmjopen-2020-045593 Retrieved from https://hdl.handle.net/10161/21951.

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Scholars@Duke

Sinnott-Armstrong

Walter Sinnott-Armstrong

Chauncey Stillman Distinguished Professor of Practical Ethics

Walter Sinnott-Armstrong is Chauncey Stillman Professor of Practical Ethics in the Department of Philosophy and the Kenan Institute for Ethics at Duke University. He has secondary appointments in the Law School and the Department of Psychology and Neuroscience, and he is core faculty in the Duke Center for Cognitive Neuroscience, the Duke Institute for Brain Sciences, and the Duke Center for Interdisciplinary Decision Sciences. He serves as Resource Faculty in the Philosophy Department of the University of North Carolina at Chapel Hill, Partner Investigator at the Oxford Centre for Neuroethics, and Research Scientist with The Mind Research Network in New Mexico. He has visited at National Cheng Kung University in Taiwan, the Macquarie Research Center for Agency, Values, and Ethics in Australia, and the National Institutes of Health in Washington. He has received fellowships from the Harvard Program in Ethics and the Professions, the Princeton Center for Human Values, the Oxford Uehiro Centre for Practical Ethics, the Center for Applied Philosophy and Public Ethics at the Australian National University, and the Sage Center for the Study of the Mind at the University of California, Santa Barbara. He has served as co-chair of the Board of Officers of the American Philosophical Association, co-director of the MacArthur Law and Neuroscience Project, and co-PI of the project on the Neuroscience and Philosophy of Free Will and Moral Responsibility at Chapman University. He earned his bachelor’s degree from Amherst College and his doctorate from Yale University. He has published widely on ethics (theoretical and applied as well as meta-ethics), empirical moral psychology and neuroscience, philosophy of law, epistemology, philosophy of religion, and informal logic. Most recently, he is the author of  Think Again: How to Reason and Argue, Morality Without God?and Moral Skepticisms; co-author with Robert Fogelin of Understanding Arguments, Ninth Edition, and with Jesse Summers of Clean Hands: Philosophical Lessons of Scrupulosity; and editor of Moral Psychology, volumes I-V. His numerous articles have appeared in a variety of philosophical, scientific, and popular journals and collections. He performs various experiments in moral psychology and brain science with his Moral Attitudes and Decisions (MAD) Lab. He is working on one book on moral artificial intelligence and another book that will develop a contrastivist view of freedom and responsibility. He co-directs Summer Seminars in Neuroscience and Philosophy (SSNaP) with Felipe De Brigard and teaches a popular MOOC, Think Again, on the Coursera website with Ram Neta. 


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