Ethics in the worst of times: An ethical framework for rationing health resources in Minnesota during a severe pandemic

In 2007, the Minnesota Department of Health contracted with ethicists from the Minnesota Center for Health Care Ethics and the University of Minnesota Center for Bioethics to develop an ethical framework for rationing scarce health resources during a severe pandemic. In phase one of the Minnesota Pandemic Ethics Project, we worked intensively for nearly a year with a community panel and expert workgroups, collectively totaling over 100 participants from public, private, nonprofit and academic sectors, to consider the rationing of five resources as case studies: vaccines, antivirals (both for treatment and prophylaxis), N95 respirators, surgical masks, and mechanical ventilators. Together we agreed upon preliminary recommendations about the common ethical commitments, principles and goals that should guide rationing these resources, and the ways in which goals diverge between classic public health interventions and tertiary care.

The notion of explicit rationing is foreign to Americans accustomed to abundance. Participants had different language and jargon, experience and expertise, which both challenged and enriched our process. Some in the room were very concrete thinkers, while others worked best at conceptual levels. We incorporated several group process techniques to facilitate the work.

The group concluded that no single ethical principle or value was sufficient to ground decision-making. Rather, the challenge is to balance multiple principles and values in order to best serve the public's health and act fairly in the process. We considered emerging, and in some cases conflicting, federal guidance.

This session reports both our process and recommended ethical frameworks for rationing.