Allocating Scarce Medical Resources in a Pandemic: Maryland’s Approach

Officials in the United States and other countries are grappling with challenging ethical dilemmas over how best to allocate limited life-sustaining resources during the COVID-19 coronavirus pandemic. In 2009, the Institutes of Medicine issued a report on how state governments can establish guidelines for providing care and allocating critical resources during extreme public health crisis. Since the publishing of that report, several U.S. states have made efforts to develop decision making standards on allocating scarce medical resources during a health emergency. To aid these efforts, RESOLVE has collaborated with ethicists and medical experts to design and lead community engagement efforts on this issue in three U.S. states. You can learn more about RESOLVE’s work on this issue here and in a number of other blogposts published in recent weeks.

Maryland recently conducted a statewide effort to gather community input on this topic and to develop a framework for rationing limited life-sustaining resources. From 21012-2015, RESOLVE partnered with the Johns Hopkins Berman Institute and University School of Medicine, the Health System’s Office of Emergency Management, and the Center for Health Security to gather public input on how to address complex questions about rationing care in Maryland. By engaging “lay” community members and health care providers alike, this project sought to collectively consider decision-making criteria for allocating ventilators during a pandemic. These discussions used a deliberative democracy model to probe views on different principles for allocating scarce medical resources.

Over the years, our esteemed project partners have developed several insightful publications about this work, with many recent articles reflecting on how this effort has helped the state of Maryland prepare for the COVID-19 coronavirus pandemic. Given the current circumstances, we have highlighted below select articles about this work, in the hopes that this may be useful to other states and communities that are currently developing frameworks for making decisions about how to allocate resources. 

• An overview of the community engagement effort, which was published in the Annals of the American Thoracic Society in 2014.
• An article published in the CHEST Journal in 2019 offering a framework to guide statewide allocation of scarce mechanical ventilation during a pandemic.
• A recent article in the Washington Post highlighting findings from the community engagement effort and how this can help inform Maryland’s response to the COVID-19 coronavirus pandemic.
• A recent op-ed in The Hill on how to communicate about allocating scarce medical resources during the COVID-19 coronavirus pandemic.
• A recent article in the Journal of Participatory Medicine comparing Maryland and Texas findings, and showing how deliberative democracy contributes to more culturally competent allocation approaches.

For more information about this project or RESOLVE’s additional work on this issue, please contact Senior Mediator Beth Weaver.

Beth Weaver
Senior Mediator
April 10, 2020