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GeriPal - A Geriatrics and Palliative Care Podcast

Alex Smith and Eric Widera

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GeriPal - A Geriatrics and Palliative Care Podcast
39 MINMAY 13
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We are rationing in the US. We may not be explicitly rationing, as we're going to discuss on this podcast, but we are rationing - in the way we allocate fewer tests and less PPE to nursing homes compared to hospitals, in the way we allow hospitals and states to "fend for themselves" resulting in those hospitals/states with better connections and more resources having more PPE and testing availability.

And in some parts of the world, ICU and ventilator resources are scare, and they are rationing by age. We talked on our last podcast about decisions Italy made to ration by age, and on this podcast we talk about two countries in South America we have heard are using age as a criteria for rationing ventilators.

In this context, we are fortunate to welcome Tim Farrell, Associate Professor of Geriatrics at the University of Utah and Vice Chair of the American Geriatrics Society (AGS) Ethics Committee, and returning guest Doug White, Vice Chair and Professor at the University of Pittsburgh School of Medicine.

In our prior podcast with Doug we talked about his University of Pittsburgh (and colleagues) policy for allocation of scarce resources that has been adopted by over a hundred hospitals. Today's podcast is focused on the release of the AGS guidelines for allocation of scarce resources and the accompanying paper that explains the ethical rationale behind the AGS ethics committee's decisions. Both papers are available now on the Journal of the American Geriatrics Society (JAGS) COVID19 webpage. We talk about how the AGS and Pittsburgh guidelines are far more similar than different, and the ethical principles that led them to make the choices they made, and how these choices have evolved over time.

The two issues we cover in depth are: (1) Should age be used to ration scarce resources? How should age be used, if at all, as an "up front" consideration, or a "tiebreak?" And (2) How should we account for socioeconomic determinants of health in resource allocation decision making?

Stay healthy and safe, and keep doing the good work that you're doing, GeriPal listeners.

-@AlexSmithMD