Ethical Rationing of Personal Protective Equipment to Minimize Moral Residue During the COVID-19 Pandemic

This article proposes systems for the fair distribution of scarce resources to healthcare providers. It builds on classic ethical structures and adapts them to the equitable distribution of personal protective equipment (PPE) to clinicians at risk of contracting novel corona virus-19 (COVID-19). The article also defines systems of allocation that are generally considered unethical and are to be avoided. We emphasize that policies must be transparent, collaborative, applied equally, and have a system of accountability. It is recognized that unless the supply of PPE is quickly replenished, or viable alternatives to traditional equipment are devised in the coming days to weeks, hospitals and healthcare systems will face the difficult task of rationing PPE to at-risk clinicians. This paper suggests an ethical framework for that process. ((C)2020 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.)