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The Role of Racial Bias When Medical Experts Are Making Decision on the Allocation of Scarce Resources

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Societies are facing medical resource scarcities, inter alia due to increased life expectancy and limited health budgets and also due to temporal or continuous physical shortages of resources like donor organs

This makes it challenging to meet the medical needs of all. Ethicists provide normative guidance for how to fairly allocate scarce medical resources, but legitimate decisions require additionally information regarding what the general public considers to be fair.

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Thus, it refrained from issuing recommendations about specific types of data that should be gathered. The Implementation Team recommends that partnerships between MDH, the State Community Health Services Advisory Committee (SCHSAC), local health departments (LHDs) and tribal liaisons throughout the state attend specifically to efforts, both in the planning stages and during a pandemic, to alleviate health disparities and reduce access barriers. These partnerships will be critical to the promotion of equity given the special expertise of each of the partners. LHDs know the demographics, social and economic conditions, and general health needs of the people whom they serve. However, only the state has the entire picture and thus the capacity to compare mortality and morbidity across regions. Additional information will result from surveillance at the federal and even global level

The Implementation Team recommends collaboration between LHDs and social service agencies, home care providers, free clinics, community organizations such as the Salvation Army, faith-based communities that serve low income people, etc. These groups work directly with populations that are most likely to face barriers to access during a pandemic.

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There has been much discussion of resource allocation in medical systems, in the United States and elsewhere. In large part, the discussion is driven by rising costs and the resulting budget pressures felt by publicly funded systems and by both public and private components of mixed health systems. In some publicly funded systems, resource allocation is a pressing issue because resources expended on one disease or person cannot be spent on another disease or person (Hoffman, S. 2009). Some of the same concern arises in mixed medical systems with multiple funding sources. Although much has been written on resource allocation issues in medicine, there has been less discussion about how resource allocation affects public health. Federal, state, and local public health budgets in the United States constrain investments in health at those levels

In this regard, they are more like some foreign medical systems than the more fragmented and mixed public-private medical system of the United States. In the context of budget cuts domestically and in many countries responding to an economic downturn, how to invest (and allocate) public health resources is a pressing issue (Christian, M.D.).

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As can be seen, in addition, the duty of health care workers to provide care needs to be weighed against other potentially conflicting obligations

Avoidance of high-risk exposure may be appropriate for clinicians who are older, have dependents, are pregnant, are immunocompromised, or have chronic cardiopulmonary disease. The supply of PPE may also play a role in these decisions. However, those who are making duty schedules may experience significant difficulties in balancing competing interests among clinicians. For example, it is difficult to weigh mitigating exposure risk for a single caregiver of children versus a single caregiver for an elderly parent versus a 2 clinician family with no extended support network. These questions do not have easy answers but require careful consideration.

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Christian, M.D., L. Hawryluck, R.S. Wax, et al. 2006. Development of a triage protocol for critical care during an influenza pandemic. Canadian Medical Association Journal 175(11): 1377–1381.

Hick, J., L. Rubinson, D. O’Laughlin, and J. Farmer. 2007. Allocating ventilators during largescale disasters—Problem, planning, and process. Critical Care 11(3): 217–226.

Hoffman, S. 2009. Preparing for disaster: Protecting the most vulnerable in emergencies. UC Davis Law Review 42: 1491–1547.

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