Table 1.
The Israeli Commission on Prioritization of Scarce Medical Resources: Decisions and Reasoning for Selected Issues
| Issue | Decision | Reasoning |
|---|---|---|
| A. General Principles | ||
| Greatest good for greatest number | Saving the most lives (not the most life-years) | Maximal societal benefit (utilitarian), sanctity of life, equality |
| Equity | Same criteria for all patients | Fairness, public confidence |
| Transparency | Public disclosure | Public confidence |
| B. Prioritization criteria | ||
| Medical criteria | Consistency Nonmedical criteria lead to inequality, bias, and discrimination, and benefit is not maximized | |
| Short-term survival | Prediction of short-term survival is much more accurate than prediction of long-term survival Using long-term survival would significantly bias against older individuals and people with disabilities |
|
| Tie-breaking | First come, first served | Fairness, transparency |
| C. Specific patient features | ||
| Age | Not a stand-alone criterion, only as part of combined risk assessment | Sociocultural respect for the elderly |
| Disability | Not a stand-alone criterion, only as part of combined risk assessment of short-term survival | Equality and lack of discrimination Functional status can be used for prioritization only if it affects short-term survival |
| Health-care workers | No prioritization upfront | Equality, public confidence |
| Prioritize only if needed to address staff shortages and then only as a tie-breaker | Recognition of risk and of service (for all workers with patient contact, not only health professionals) | |
| Palliative care | Especially for patients not admitted to ICU or ventilated | Beneficence |
| D. Implementation | ||
| Initiation of policy implementation | Overwhelmed medical system | Emergency triage is acceptable only in crisis situations |
| Formal declaration of an emergency situation by the Ministry of Health | Formal announcement is critical for public trust | |
| Local triage decisions | Two senior physicians, institutional triage committee available for consultation, not mandatory | Mandating requirement of an institutional committee is unworkable in the local setting during emergencies |
| National triage decisions | Establish a national triage committee, available for amendments | Triage situations not covered by current policies may arise |