Internists Say Prioritization, Allocation of Resources and Stewardship Must Not Result in Discrimination During COVID-19 Emergency

Philadelphia (March 27, 2020) —The American College of Physicians (ACP) is emphasizing the need for fairness and equality to guide health care delivery during the COVID-19 health crisis. ACP says resource allocation decisions must not be based on unjust or prejudicial criteria that result in discrimination, but should be made based on patient need, prognosis, and effectiveness, and allocation of treatments must maximize the number of patients who will recover, not the number of ‘life years.’ The direction was provided as part of a new policy on “Non-Discrimination in the Stewardship and Allocation of Resources During Health System Catastrophes Including COVID-19.”

“During a public health crisis such as the current COVID-19 situation, health care systems may become stressed and resources scarce. Physicians and other health care professionals may be put in challenging positions to triage treatment,” said Robert McLean, MD, MACP, president of ACP. “We must ensure fairness and equality in decisions about resource allocation, prioritizing patient needs, prognosis, medically indicated treatment and recovery for the greatest number of patients.”

The policy reads:

“Large-scale health catastrophes, including from infectious causes, can overwhelm health care systems, stressing the norms of health care delivery and the patient–physician relationship. Triage is often needed; stewardship and allocation of resources becomes even more necessary in overwhelmingly high demand circumstances. While the physician’s responsibility remains with the health and welfare of individual patients under the physician’s care, the well-being of the community as a whole must also be considered at a systems level including in institutional policies and other guidelines.  This requires prioritization of resources.  But prioritization must not be discrimination.  Fairness and other professional responsibilities of physicians require that clinicians, their institutions and health care systems not discriminate against a class or category of patients (e.g., based on age, race, ethnicity, disability, sex, gender identity, social status or other personal characteristics).  Treatment decisions must not be based on unjust and prejudicial criteria.

“Many clinicians and institutions are going above and beyond the call of duty in these difficult times and we applaud them.  Along with the traditional duty to care, fairness and equality must be promoted and guide health care delivery during health system catastrophes such as pandemic coronavirus.  When, as in times of health system catastrophe, routine “first come, first served” or “sickest first” approaches are no longer appropriate, resource allocation decisions should be made based on patient need, prognosis (determined by objective scientific measures and informed clinical judgment) and effectiveness (i.e., the likelihood that the therapy will help the patient recover).  Allocation of treatments must maximize the number of patients who will recover, not the number of “life-years,” which is inherently biased against the elderly and the disabled.

“Physicians should also participate in the development of guidelines for the delivery of health care in times of catastrophe with attention to health disparities that may affect populations or regions. Fair process requires transparency, consistency, proportionality and accountability.

We must always act and speak as individual clinicians, but also consider our role within the profession of medicine, and within society, in a manner that demonstrates our compassionate commitment to all patients, with equality and fairness.” 

Dr. McLean continued, “Everything that can be done should be done to prepare for and avoid circumstances of scarce resources and, if necessary, to safely transfer patients to institutions with greater resources and capacity if possible. But if such circumstances arrive, the solution is not to discriminate against classes of patients and ask physicians to pit one group against another. We are all in this together.”


About the American College of Physicians

The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 159,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook, and Instagram.

Contact:​ Edward Vassallo, (215) 351-2761​,