Australian Capital Territory COVID-19 Intensive Care Triage Principles and Process: Consumer, Carer, and Community Consultation Report

Abstract

Executive Summary

The ACT Clinical Health Emergency Coordination Centre engaged the research team in May 2020 to conduct a review of the ethical decision-making processes for allocating critical care resources should demand exceed supply during the global COVID-19 pandemic.

ES.1 Methodology

The methodology for this review broadly included undertaking a scoping review of ethical decision-making frameworks in other jurisdictions; a systematic review of consumer, carer, and community engagement in ethical decision-making frameworks; and a series of consultative processes. The outcomes from each of these activities were then integrated into the ACT Ethical Decision-Making Framework which had been drafted by the Clinical Ethics Committee of Canberra Health Services earlier in the pandemic. Based on a ‘Scoping Review of Ethical Decision-Making Frameworks’ and a ‘Systematic Review of Consumer Engagement in Ethical Decision-Making Frameworks’, a consultation process was developed whereby relevant consumer, carer, and community groups from across the ACT region were given a range of opportunities to provide input into what principles should form the basis of ethical decision-making in the context of COVID-19 should demand for acute care resources exceed capacity.

ES.2 Recommendations

The recommendations developed through analysis of the consultations are: 1. There should be a primacy of Human Rights underpinning decision-making processes, 2. Non-discrimination should be embedded in triage, 3. Triage should be primarily based on immediate health concerns (that is, with no assumptions or value judgements about people’s health conditions), 4. Triage processes should minimise bias, and 5. Triage processes should be transparent.