Ventilator withdrawal for reallocation during a COVID-19 surge needs a deeper discussion

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Jonathan Breslin
Jill Oliver

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Abstract

Many jurisdictions around the world have developed ventilator triage protocols in the event that demand for  ventilation during the COVID-19 pandemic overwhelms the available supply. These protocols would be used to determine which patients get priority access to potentially life-saving ventilation. One particularly controversial element of these protocols is what we refer to as “withdrawal for reallocation” – that is, the practice of withdrawing a ventilator from one patient in order to provide it to another patient with a  comparatively higher likelihood of benefit. This element raises several ethical issues that have not been given due consideration in the protocols themselves and the literature on the topic. In this paper we highlight these issues and provide recommendations for addressing them.