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This article has been cited by other articles in PMC. Abstract While rationing of healthcare resources is inevitable even in the most developed economies, particularly on the wake of a pandemic, ethical basis of its implementation needs to be reviewed.
Introduction A Pandemic episode of any disease is a sudden potential life-threatening attack that rises alarm for global attention towards healthcare. What is rationing? Rationing — an inevitable concept In many industrialized countries, social goods draw funds from a common source—including healthcare, education, defense, infrastructure, environmental protection, and public health. Objective To review the concept of rationing in healthcare resources during a pandemic and analyse the need for country-specific ethical guidelines in its implementation.
Materials and methods We searched in various research databases like PubMed and Cochrane for articles reporting the concept of rationing of healthcare resources and its ethical implications.
Search strategy A search of literature for this systematic review was without any restriction on the date of publication. Table 1 Systematic review search strategy. Open in a separate window. Exclusion criteria Conference abstracts, books and grey literature were excluded. Screening The search titles were uploaded in Zotero software and scrutinized for duplicates.
Data extraction The data extractions from the screened studies were done in the excel spreadsheet. Search results Search in the databases revealed titles out of which titles were found relevant to the research objective. Figure 1. Table 2 Characteristics of reviewed studies. Results Rationing of healthcare resources is found to be a routine in some sectors of healthcare while the concept is under practice all over the world during times like pandemics.
Ethical considerations in pandemic response The concept of ethics in healthcare in general varies from the principles considered during a pandemic episode.
Figure 2. Rationing and ethics Rationing of resources occurs at multiple levels, which can be macro allocation — which occurs at the societal level and micro allocation — which occurs within healthcare setups like bedside decisions and ICU setups. Issues to be addressed Issues with healthcare rationing arise from poor planning and implementation of unsuccessful policies. Sectors of people and their priorities People with different levels of exposure need different types of things.
Frontline healthcare workers They are required to reach the maximum number of population and are encouraged to serve to help them remain infection-free. Infected patients Their need depends upon the stage of disease progression, where those in the early stage and symptomatic, would need isolation and certain vitamins and minerals.
Services Testing Testing facilities and the capacity of several tests performed are very much limited in many countries.
Management As of now managing COVID refers to providing supportive therapy to prevent or delay the complications, symptomatic management, rest and nutritional intervention. Limitations Our review focussed on the rationing of healthcare resources during pandemic situations and we could not discuss more rationing during COVID due to limited references.
Conclusion While the entire world is dreaming of abundance, which is also seen in many developed countries in a wide range of goods and facilities even including healthcare resources, a pandemic episode brings up a completely different situation. Ethical considerations Not applicable. Funding statement No funding source. Disclosure of interest The authors declare that they have no competing interest.
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Responsibility in healthcare across time and agents. Moosa, M. PloS ONE 11 , e Daniels, N. Setting Limits Fairly. Learning to Share Resources for Health. Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Valerie A. Reprints and Permissions.
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Article Google Scholar Luyckx Authors Mohammed R. Moosa View author publications. View author publications. Ethics declarations Competing interests The authors declare no competing interests. Supplementary information. Subscriber sign in You could not be signed in, please check and try again. Username Please enter your Username. Password Please enter your Password. Forgot password? Don't have an account? Sign in via your Institution. You could not be signed in, please check and try again.
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