Identifying prioritization criteria to supplement critical care triage protocols for the allocation of ventilators during a pandemic influenza.

The purpose of this study was to identify supplementary criteria to provide direction when the Ontario Health Plan for an Influenza Pandemic (OHPIP) critical care triage protocol is rendered insufficient by its inability to discriminate among patients assessed as urgent, and there are insufficient critical care resources available to treat those in that category. To accomplish this task, a Supplementary Criteria Task Force for Critical Care Triage was struck at the University of Toronto Joint Centre for Bioethics. The task force reviewed publically available protocols and policies on pandemic flu planning, identified 13 potential triage criteria and determined a set of eight key ethical, legal and practical considerations against which it assessed each criterion. An online questionnaire was distributed to clinical, policy and community stakeholders across Canada to obtain feedback on the 13 potential triage criteria toward selecting those that best met the eight considerations. The task force concluded that the balance of arguments favoured only two of the 13 criteria it had identified for consideration: first come, first served and random selection. The two criteria were chosen in part based on a need to balance the clearly utilitarian approach employed in the OHPIP with equity considerations. These criteria serve as a defensible "fail safe" mechanism for any triage protocol.

Responding to discriminatory requests for a different healthcare provider.

Patient requests for a healthcare provider of a particular race or sexual orientation create a conflict of obligations. On the one hand, providers have a duty to deliver clinically indicated care consistent with patient preferences. On the other hand, providers have legal, professional, and organizational assurances that they should not suffer workplace discrimination. Protecting healthcare providers from harm while maintaining obligations to patients requires unambiguous messaging to both parties. Providers need to be clear that their organization will not be complicit in discrimination against them, instead supporting their needs and preferences for management of the situation. In a context of patient-centered care, harm principle-based boundaries of respect for autonomy must be defined. A Caregiver preference guideline developed and used at University Health Network, Toronto provides a standardized way for the organization to decide when it will honor patient requests for providers of a particular background. This process stresses dialogue, assessment of clinical feasibility, and empowerment and support for affected care providers.

Sex selection and disability avoidance: is their opposed treatment conceptually consistent?

Sex selection and disability avoidance receive opposed treatment in bioethics literature, legislative practice and public opinion. However, some theorists question this state of affairs by drawing analogies between the harmful consequences of these practices. This paper shares their disapproval of gender selection and disability avoidance, but bases its resistance to these practices on an examination of the concepts of gender and disability. Here it identifies conceptual confusions as another cause of approval of sex selection and disability avoidance. Further, in clarifying the nature of the concepts at issue, and their relationship with the subjects that they apply to, this discussion highlights the existence of relevant analogies between the concepts of gender and disability. Here the social construction and universality of gender and disability allow their differential treatment to be resisted at the conceptual level, creating a strong foundation for more consequentialist arguments against sex selection and disability avoidance.