Revisiting the equity debate in COVID-19: ICU is no panacea

Angela Ballantyne* (Corresponding Author), Wendy A Rogers, Vikki Entwistle, Cindy Towns

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)
5 Downloads (Pure)


Throughout March and April 2020, debate raged about how best to allocate limited intensive care unit resources in the face of a growing COVID-19 pandemic. The debate was dominated by utility-based arguments for saving the most lives or life-years. These arguments were tempered by equity-based concerns that triage based solely on prognosis would exacerbate existing health inequities, leaving disadvantaged patients worse off. Central to this debate was the assumption that ICU admission is a valuable but scarce resource in the pandemic context.
In this paper, we argue that the concern about achieving equity in ICU triage is problematic for two reasons. First, ICU can be futile and prolong or exacerbate suffering rather than ameliorate it. This may be especially true in COVID-19 patients with emerging data showing that most who receive access to a ventilator will still die. There is no value in admitting patients with poor prognostic indicators to ICU to meet an equity target when intensive critical care is contrary to their best interests. Second, the focus on ICU admission shifts focus away from important aspects of COVID-19 care where there is greater opportunity for mitigating suffering and enhancing equitable care.
We propose that the focus on equity concerns during the pandemic should broaden to include providing all people who need it with access to the highest possible standard of end of life care. This requires attention to culturally safe care in the following interlinked areas: palliative care, communication and decision support and advanced care planning.
Original languageEnglish
Pages (from-to)641-645
Number of pages5
JournalJournal of Medical Ethics
Issue number10
Early online date22 Jun 2020
Publication statusPublished - Oct 2020

Bibliographical note

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No commercial re-use. See rights and permissions. Published by BMJ. This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.


  • living wills/advance directives
  • clinical ethics
  • end of life care
  • distributive justice
  • palliative care
  • end-of-life care
  • advance directives
  • living wills
  • CARE


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