In crisis situations where many people are sick or injured, health resources can quickly become depleted. This includes essential equipment such as ventilators, but it also includes places and people, such as nurses. To establish a national, ethical framework for decision making when the normal way of doing business in health care cannot be met, the Institute of Medicine (IOM) convened an expert panel to combine their knowledge and public input in developing a report. This panel included Cheryl Peterson, MSN, RN, Director of American Nurses Association (ANA) Nursing Practice and Policy and Marianne Matzo, PhD, GNP-BC, FPCN, FAAN, member of the Oklahoma Nurses Association. The report emphasizes that the ethics of health care do not change – health care providers are always, no matter what the situation, expected to provide the best care that they can – but that the decisions and the care delivery system might. Rationing of ventilators and determining which casualties will not receive treatment are just some of the tough decisions that need to be made when resources are scarce.
The report offers a national framework as a starting point in developing a robust system to guide the public, health care professionals and institutions, and governmental entities at all levels in making those tough decisions. It recommends that crisis standards of care entail 1) Fairness, 2) Equitable Process, 3) Community and Provider Engagement, and 4) The Rule of Law.