Public perspectives on COVID-19 triage protocols for access to critical care in extreme pandemic context.

COVID-19 triage protocols are resource allocation processes to deal with the potential lack of resources in Intensive Care Units (ICU). They have given rise to numerous ethical issues and controversies. Among them is the fear that people will be denied access to ICU on the basis of judgments about their quality of life, social value, frailty or age.

Assessing the Quality of an Online Democratic Deliberation on COVID-19 Pandemic Triage Protocols for Access to Critical Care in an Extreme Pandemic Context: Mixed Methods Study.

Background: Online democratic deliberation (ODD) may foster public engagement in new health strategies by providing opportunities for knowledge exchange between experts, policy makers, and the public. It can favor decision-making by generating new points of view and solutions to existing problems. Deliberation experts recommend gathering feedback from participants to optimize future implementation.

What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic?

Background: The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario's protocols were presented to the public in a democratic deliberation during the summer of 2022.

Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review.

Background: To reduce the arbitrariness in the allocation of rare resources in intensive care units (ICU) in the context of the pandemic, tiebreakers were considered in some COVID-19 triage algorithms. They were also contemplated to facilitate the tragic decisions of healthcare workers when faced with two patients with similar prognosis and only one ICU bed available. Little is known about the public's perspective on tiebreakers.

[The distribution of health resources: a hybrid model of equality and maximization].

In the allocation of resources for health care, it is generally acknowledged that models based exclusively either on efficiency and maximizing the cost/benefit ratio of interventions, or on equity and justice through the notion of "maximin," are unsatisfactory when taken separately. To fill this gap, this commentary suggests a hybrid model of resource allocation that integrates the idea of a random distribution of resources using a lottery. The general aim of this model is to safeguard the notions of justice and equal access to resources to the maximum extent possible in a climate where budget restrictions and the economic downturn may lead to future reductions in services.

[The Canadian plan to struggle against influenza epidemics: legal plea for a normative global approach].

The Canadian pandemic influenza plan for the health sector lies within a logic of precaution aiming at the effective prevention of human infections by the highly pathogenic influenza virus H5N1. Since the plan is designed as guidelines elaborated by the Canadian authorities to regulate behaviours should a pandemic occur, it possesses an eminent normative value. Yet, in spite of the attention being given by the experts to scientific and logistic measures, it seems clear that the Canadian plan has not undergone a thorough normative analysis, although it includes ethical considerations.