Equitable chances: a novel weighted lottery approach to crisis standards of care

Abstract: Disasters that produce scarcity tend to fall hardest on disadvantaged communities, especially racial and ethnic minority groups. How exactly Crisis Standards of Care (CSS) protocols for triage of life-support should take this context into account remains bioethically controversial.

Panelist 1, a pulmonary critical care physician and clinical ethicist, will overview the current state of CSC triage protocols in the US. They will describe how most state policies would exacerbate health inequities by relying on the racially biased Sequential Organ Failure Score (SOFA) for triage. Panelist 2, a bioethicist and health policy scholar, will introduce equitable chances, a novel weighted lottery approach that uses place-based disadvantage indices to mitigate health inequities. They will describe how the equitable chances protocol uses lottery weights carefully designed to be in proportion to the burden of the current crisis and develop a bioethical argument for this approach.

Panelist 3, a pulmonary and critical care physician and data scientist, will report the results of an ICU Crisis simulation model, comparing equitable chances and SOFA-based triage protocols in a regional cohort of critically ill adults. The results will demonstrate that the equitable chances protocol saves slightly more lives than SOFA category triage and allocates more life support to disadvantaged neighborhoods. Panelist 4, a former state policymaker with experience developing CSCs, will discuss strategies for building consensus and implementing an equitable triage protocol. They will also respond to potential objections to equitable chances and consider the public reaction to the proposal.