In the newest contribution to Pediatrics’ Ethics Rounds (10.1542/peds.2020-012542), Antiel et al consider whether pediatric patients should be prioritized for life-saving treatment, such as ECMO, if such treatment needs to be rationed during the COVID-19 pandemic. Three groups of commentators agree that younger individuals should be prioritized and that giving less priority to older individuals does not imply they have lower quality of life or social worth. The commentators differ in the details.
Antiel and Curlin argue that younger age should be used as the deciding factor between individuals with similar prognoses because younger individuals have lived through fewer life stages. Presad and White also emphasize the importance of having the opportunity to live through life’s stages and distinguish this from using life-expectancy, whose use exacerbates health disparities. Zhang, Glickman, and Emanuel defend a modified youngest-first approach as part of a multi-principle framework. They prioritize adolescents and young adults over infants because the former have developed attachments to their futures and received investments from their communities. Lantos concludes “prioritizing younger patients for scarce resources is not just ethically permissible; it is the epitome of fairness.”
These commentators provide strong arguments for prioritizing pediatric patients, a conclusion which may be consistent with many pediatricians and other pediatric healthcare providers’ moral intuitions. The commentators’ views can be contrasted with the American Geriatrics Society’s position statement on this topic which argues that making decisions about medical treatment based on membership in a class, such as age group, is unjust. Link to this month’s Ethics Rounds and see if you find their arguments compelling.