Assignment: Identifying & Analyzing Ethical Issues in Ventilator Allocation

Assignment: Identifying & Analyzing Ethical Issues in Ventilator Allocation ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Identifying & Analyzing Ethical Issues in Ventilator Allocation I need support with this Writing question so I can learn better. Assignment: Identifying & Analyzing Ethical Issues in Ventilator Allocation The purpose of this assignment is to identify and analyze the ethical issues in the attached document, “Ventilator Allocation Guidelines”, issues by the New York State Department of Health. This document was produced in November 2015, long before the emergence of COVID-19. Frequently in your careers you will have a massive amount of data presented to you and will be asked to summarize issues and provide meaning in the current context. I personally found this document interesting, informative, challenging, and at times confusing. The executive summary contains a lot of information, followed by sections on clinical ventilator allocations protocols for adult, pediatric, and neonatal patients. You should focus only on the adult guidelines beginning on page 12. This section is still approximately 70 pages. I am not asking you to read every page of this document in detail. You should examine the document and comment on the various ethical issues that you identify. Each of you will have a very different approach to this assignment. It is interesting to see the various stakeholders that contributed to this document (see page 10). You can see that it is not just clinical professionals who are deciding critical ethical issues in healthcare. Your specific task is to provide an approximately three-page summary of what you observed as the key ethical issues in the document and how the guidelines addressed these issues. Assignment: Identifying & Analyzing Ethical Issues in Ventilator Allocation3 pages APA style, please see the attached file for this paper Thank you ventilator_guidelinesnewyork.pdf VENTILATOR ALLOCATION GUIDELINES New York State Task Force on Life and the Law New York State Department of Health November 2015 Current Members of the New York State Task Force on Life and the Law Howard A. Zucker, M.D., J.D. LL.M. Commissioner of Health, New York State Karl P. Adler, M.D. Cardinal’s Delegate for Health Care, Archdiocese of NY Donald P. Berens, Jr., J.D. Former General Counsel, New York State Department of Health Rabbi J. David Bleich, Ph.D. Professor of Talmud, Yeshiva University, Professor of Jewish Law and Ethics, Benjamin Cardozo School of Law Rock Brynner, Ph.D., M.A. Professor and Author Karen A. Butler, R.N., J.D. Partner, Thuillez, Ford, Gold, Butler & Young, LLP Yvette Calderon, M.D., M.S. Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine Carolyn Corcoran, J.D. Principal, James P. Corcoran, LLC Nancy Neveloff Dubler, LL.B. Consultant for Ethics, NYC Health & Hospitals Corp., Professor Emerita, Albert Einstein College of Medicine Paul J. Edelson, M.D. Professor of Clinical Pediatrics, College of Physicians and Surgeons, Columbia University Joseph J. Fins, M.D., M.A.C.P. Chief, Division of Medical Ethics, Weill Medical College of Cornell University Rev. Francis H. Geer, M.Div. Rector, St. Philip’s Church in the Highlands Samuel Gorovitz, Ph.D. Professor of Philosophy, Syracuse University Cassandra E. Henderson, M.D., C.D.E., F.A.C.O.G. Director of Maternal Fetal Medicine, Lincoln Medical and Mental Health Center Hassan Khouli, M.D., F.C.C.P. Chief, Critical Care Section, St. Luke’s – Roosevelt Hospital Fr. Joseph W. Koterski, S.J. Professor, Fordham University Rev. H. Hugh Maynard-Reid, D.Min., B.C.C., C.A.S.A.C. Director, Pastoral Care, North Brooklyn Health Network, New York City Health and Hospitals Corporation John D. Murnane, J.D. Partner, Fitzpatrick, Cella, Harper & Scinto Karen Porter, J.D., M.S. Professor, Brooklyn Law School Robert Swidler, J.D. VP, Legal Services, St. Peter’s Health Partners Sally T. True, J.D. Partner, True, Walsh & Sokoni, LLP Task Force on Life and the Law Staff Stuart C. Sherman, J.D., M.P.H. Executive Director Susie A. Han, M.A., M.A. Deputy Director, Principal Policy Analyst Project Chair of the Ventilator Allocation Guidelines Valerie Gutmann Koch, J.D. Special Advisor; Former Senior Attorney Task Force reports should not be regarded as reflecting the views of the organizations with which Task Force members are associated. Letter from the Commissioner of Health Dear New Yorkers, Protecting the health and well-being of New Yorkers is a core objective of the Department of Health. During flu season, we are reminded that pandemic influenza is a foreseeable threat, one that we cannot ignore. In light of this possibility, the Department is taking steps to prepare for a pandemic and to limit the loss of life and other negative consequences. An influenza pandemic would affect all New Yorkers, and we have a responsibility to plan now. Part of the planning process is to develop guidance on how to ethically allocate limited resources (i.e., ventilators) during a severe influenza pandemic while saving the most lives. As part of our emergency preparedness efforts, the Department, together with the New York State Task Force on Life and the Law, is releasing the 2015 Ventilator Allocation Guidelines, which provide an ethical, clinical, and legal framework to assist health care providers and the general public in the event of a severe influenza pandemic. The first guidelines in 2007 focused on the allocation of ventilators for adults, and were among the first of their kind in the United States. The 2015 version is also groundbreaking in that it includes two new detailed clinical ventilator allocation protocols – one for pediatric patients and another for neonates. The first Guidelines were widely cited and followed by other states. We expect these revised Guidelines to have a similar effect. The Guidelines were written to reflect the values of New Yorkers, and extensive efforts were made to obtain public input during their development. While these Guidelines are comprehensive, they are by no means final. We will continue to seek public input and will revise the Guidelines as societal norms change and clinical knowledge advances. It is my sincere hope that these Guidelines will never need to be implemented. But as a physician and servant in public health, I know that such preparations are essential should we ever experience an influenza pandemic. I want to thank the members and staff of the Task Force on Life and the Law for their efforts in creating these Guidelines, which once again demonstrate New York’s strong commitment to safeguarding the health of its citizens. Sincerely, Howard A. Zucker, M.D., J.D., LL.M. New York State Commissioner of Health VENTILATOR ALLOCATION GUIDELINES New York State Task Force on Life & the Law New York State Department of Health Preface These Ventilator Allocation Guidelines (Guidelines) are an update to the 2007 draft guidelines, which presented a clinical ventilator allocation protocol for adults and included a brief section on the legal issues associated with implementing the guidelines. This update of the Guidelines consists of four chapters: (1) the adult guidelines, (2) the pediatric guidelines, (3) the neonatal guidelines, and (4) legal considerations. The adult guidelines were revised to reflect recent medical advances and further clinical analysis. The pediatric and neonatal guidelines are new and address important and previously overlooked segments of the population. Finally, the legal section provides a comprehensive examination of the various legal issues that may arise when implementing the Guidelines. The underlying goal of this work is to provide a thorough ethical, clinical, and legal analysis of the development and implementation of the Guidelines in New York State. In addition to detailed clinical ventilator allocation protocols, this document provides an account of the logic, reasoning, and analysis behind the Guidelines. The clinical ventilator allocation protocols are grounded in a solid ethical and legal foundation and balance the goal of saving the most lives with important societal values, such as protecting vulnerable populations, to build support from both the general public and health care staff. Assignment: Identifying & Analyzing Ethical Issues in Ventilator Allocation These Ventilator Allocation Guidelines provide an ethical, clinical, and legal framework that will assist health care workers and facilities and the general public in the ethical allocation of ventilators during an influenza pandemic. Because the Guidelines are a living document, intended to be updated and revised in line with advances in clinical knowledge and societal norms, the ongoing feedback from clinicians and the public has and will continue to be sought. In developing a protocol for allocating scarce resources in the event of an influenza pandemic, the importance of genuine public outreach, education, and engagement cannot be overstated; they are critical to the development of just policies and the establishment of public trust. Acknowledgements The participation of clinicians, researchers, and legal experts was critical to the deliberations of the Task Force. In addition to the members of the adult, pediatric, and clinical workgroups (see Appendix B of each respective chapter) and legal subcommittee, we would like to thank Armand H. Matheny Antommaria, Kenneth A. Berkowitz, Penelope R. Buschman, Sandro Cinti, Laura Evans, W. Bradley Poss, William Schechter, and Mary Ellen Tresgallo for their invaluable insights. We would like to thank former Task Force policy interns Apoorva Ambavane, Sara Bergstresser, Jason Keehn, Jordan Lite, Daniel Marcus-Toll, Felisha Miles, Nicole Naudé, Katy Skimming, and Maryanne Tomazic for their research and editing contributions. In addition, we would like to extend special thanks to former legal interns Carol Brass, Bryant Cobb, Andrew Cohen, Marissa Geoffory, Victoria Kusel, Brendan Parent, Lillian Ringel, Phoebe Stone, David Trompeter, and Esther Warshauer-Baker. Finally, we would like to acknowledge the work of former Task Force staff members who contributed to the Guidelines. We thank former Executive Directors Tia Powell and Beth Roxland, who initiated and moved the report forward, respectively. Carrie Zoubul served as the Senior Attorney during a large portion of the research and writing of these Guidelines and oversaw the 2011 public engagement project. The Task Force’s previous reports have been instrumental in developing policy on issues arising at the intersection of law, medicine, and ethics and have impacted greatly the delivery of health care in New York. While the Task Force hopes that the Guidelines will never need to be implemented, we believe the Guidelines will help to ensure that the State is adequately and appropriately prepared in the event of an influenza pandemic. Sincerely, Susie A. Han, M.A., M.A. Deputy Director, Principal Policy Analyst Project Chair of the Guidelines Valerie Gutmann Koch, J.D. Special Advisor; Former Senior Attorney On behalf of the New York State Task Force on Life and the Law VENTILATOR ALLOCATION GUIDELINES Executive Summary I. Introduction Influenza pandemics occur with unpredictable frequency and severity. Recent influenza outbreaks, including the emergence of a powerful strain of avian influenza in 2005 and the novel H1N1 pandemic in 2009, have generated concern about the possibility of a severe influenza pandemic. While it is uncertain whether or when a pandemic will occur, the better prepared New York State is, the greater its chances of reducing associated morbidity, mortality, and economic consequences. A pandemic that is especially severe with respect to the number of patients affected and the acuity of illness will create shortages of many health care resources, including personnel and equipment. Specifically, many more patients will require the use of ventilators than can be accommodated with current supplies. New York State may have enough ventilators to meet the needs of patients in a moderately severe pandemic. In a severe public health emergency on the scale of the 1918 influenza pandemic, however, these ventilators would not be sufficient to meet the demand. Even if the vast number of ventilators needed were purchased, a sufficient number of trained staff would not be available to operate them. If the most severe forecast becomes a reality, New York State and the rest of the country will need to allocate ventilators. II. Development of the Ventilator Allocation Guidelines In 2007, the New York State Task Force on Life and the Law (the Task Force) and the New York State Department of Health (the Department of Health) released draft ventilator allocation guidelines for adults. New York’s innovative guidelines were among the first of their kind to be released in the United States and have been widely cited and followed by other states. Since then, the Department of Health and the Task Force have made extensive public education and outreach efforts and have solicited comments from various stakeholders. Following the release of the draft guidelines, the Task Force: (1) reexamined and revised the adult guidelines within the context of the public comments and feedback received (see Chapter 1), (2) developed guidelines for triaging pediatric and neonatal patients (see Chapters 2 and 3), and (3) expanded its analysis of the various legal issues that may arise when implementing the clinical protocols for ventilator allocation (see Chapter 4). To revise the adult clinical ventilator allocation protocol, a clinical workgroup comprised of individuals from the fields of medicine and ethics was convened in 2009 to develop and refine specific aspects of the clinical ventilator allocation protocol. To obtain additional public comment, the Task Force oversaw a public engagement project in 2011, which consisted of 13 focus groups held throughout the State. Furthermore, based on the results of these focus groups and its own analysis, the Task Force made additional recommendations to elaborate and expand certain sections and to include a more robust discussion of the reasoning and logic behind certain features of the protocol. These revisions appear as Chapter 1, the revised adult guidelines (the Adult Guidelines). 1 Executive Summary The Task Force approached the pediatric ventilator allocation guidelines (the Pediatric Guidelines) in two stages.Assignment: Identifying & Analyzing Ethical Issues in Ventilator Allocation First, the Task Force addressed the special considerations for pediatric and neonatal emergency preparedness and the ethical issues related to the treatment and triage of children in a pandemic, with particular focus on whether children should be prioritized for ventilator therapy over adults. Second, the Task Force convened a pediatric clinical workgroup (including specialists in pediatric, neonatal, emergency, and maternal-fetal medicine, as well as in critical care, respiratory therapy, palliative care, public health, and ethics), to develop a clinical ventilator allocation protocol for pediatric patients. Chapter 2 presents these new Pediatric Guidelines. The Task Force also organized a neonatal clinical workgroup, consisting of neonatal and maternal-fetal specialists, to discuss and develop neonatal guidelines (the Neonatal Guidelines), which appear as Chapter 3. Finally, a legal subcommittee was organized in 2008, and the Task Force devoted substantial resources to exploring the various legal issues that may arise when implementing the clinical ventilator allocation protocols. Thus, the brief summary on legal issues from the 2007 draft guidelines is replaced with a substantial discussion in Chapter 4. As a result of the Task Force’s efforts, the Ventilator Allocation Guidelines (the Guidelines) incorporate comments, critiques, feedback, and values from numerous stakeholders, including experts in the medical, ethical, legal, and policy fields. The Guidelines draw upon the expertise of clinical workgroups and committees, literature review, public feedback, and insightful commentary. Furthermore, in developing and revising the Guidelines, extensive efforts were made to obtain public input. For the public to accept the Guidelines, they must reflect the values of New Yorkers. Because research and data on this topic are constantly evolving, the Guidelines are a living document intended to be updated and revised in line with advances in clinical knowledge and societal norms. The Guidelines incorporate an ethical framework and evidence-based clinical data to support the goal of saving the most lives in an influenza pandemic where there are a limited number of available ventilators. III. Chapter Overviews This report consists of four chapters, described below. Each chapter has an abstract that summarizes the chapter. While each chapter may stand alone, the underlying ethical framework and clinical concepts are discussed in more detail in Chapter 1, Adult Guidelines. For ease of reference, at the end of the report are the adult (Appendix A), pediatric (Appendix B), and neonatal (Appendix C) clinical ventilator allocation protocols (the Clinical Protocols for Ventilator Allocation). In addition, this report has a companion document, Frequently Asked Questions, which is intended to supplement the Guidelines and answer commonly asked questions. 2 Executive Summary Chapter 1, Adult Guidelines. This chapter provides a detailed overview of the development of the Guidelines as a whole and a background on moderate and severe pandemic influenza scenarios. It also examines surge capacity, stockpiling ventilators, and creation of specialized facilities for influenza patients. An overview of the concepts used in triage (i.e., modified definitions of triage and survival), the ethical framework underlying the Guidelines, the use of triage officers or committees, pitfalls of an allocation system, and triaging ventilatordependent chronic care patients are also discussed. Next, the chapter reviews various nonclinical approaches to allocating ventilators, including distributing ventilators on a first-come first-serve basis, randomizing ventilator allocation (e.g., lottery), requiring only informal physician clinical judgment in making allocation decisions, and prioritizing certain patient categories (i.e., health care workers, patients of advanced age, and patients with certain social criteria) for ventilator therapy, and provides an analysis of other clinical ventilator allocation protocols. New York’s clinical ventilator allocation protocol for adults is presented, followed by a discussion alternative forms of medical intervention and palliative care. Finally, the chapter concludes with a discussion on communication about the Guidelines, real-time data collection and analysis, and future modification of the Adult Guidelines. Chapter 2, Pediatric Guidelines. This chapter addresses the unique considerations for pediatric emergency preparedness, explores the ethical issues related to triaging children, and discusses the pediatric clinical ventilator allocation protocol. It begins by describing how children with influenza may respond better to treatment because they have fewer underlying medical conditions that hinder recovery, and continues by examining how triaging children requires special attention. Assignment: Identifying & Analyzing Ethical Issues in Ventilator Allocation An overview of the concepts used in triage is repeated (i.e., modified definitions of triage and survival) and the use of young age as a triage factor is discussed. Next, potential features of a pediatric protocol are examined (i.e., exclusion criteria, pediatric clinical scoring systems, physician clinical judgment, time trials, response to ventilation, and duration of ventilator need/resource utilization), followed by summaries of various available pediatric guidelines (Ontario, Canada; Alaska; Florida; Indiana; Michigan; Minnesota; Wisconsin; and Utah). The chapter then discusses what age (pediatric age cut-off) should be used to determine who is a pediatric patient and weighs how to triage chronic care pediatric patients who are ventilator dependent. The second half of the chapter is devoted to the details of New York’s pediatric clinical ventilator allocation protocol, including the logic and reasoning behind the inclusion and exclusion of particular features. The chapter also discusses alternative forms of medical intervention and pediatric palliative care. Finally, the chapter addresses communication about triage, real-time data collection and analysis, and future modification of the Pediatric Guidelines. Chapter 3, Neonatal Guidelines. This chapter examines the unique challenges when triaging neonates and discusses the neonatal clinical ventilator allocation protocol. It begins with an exploration of the special considerations involved when triaging neonates, including the possible increase in the number of extremely premature neonates as a result of influenza-related complications from pregnant women. Next, the possible components of a neonatal protocol are analyzed (i.e., neonatal clinical scoring systems, physician clinical judgment, Apgar score, gestational age, and birth weight). The second half of the chapter presents New York’s neonatal clinical ventilator allocation protocol, and includes detailed explanations of why the possible factors discussed earlier are not appropriate to include. The chapter closes with comments on 3 Executive Summary alternative forms of medical intervention, palliative care, communication about triage, real-time data collection and analysis, and future modification of the Neonatal Guidelines. Chapter 4, Implementing New York State’s Ventilator Allocation Guidelines: Legal Considerations. This chapter addresses the various legal issues associated with effectively implementing the Guidelines and presents recommendations to encourage adherence to the Guidelines. This chapter begins with a … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10